Evaluation of hollow mesh augmentation on the biomechanical properties of the flexor tendon repaired with modified Kessler technique

Abstract

PurposeThe aim of the study was to test flexor tendon repair with a novel hollow mesh suture augmentation served as a centre core cable [Triple-C (Tri-C)] in an in vitro study using a turkey model. MethodsForty long digits from white turkey feet were divided into the following four groups based on repair techniques: Group 0, intact tendon without repair; Group 1, modified Kessler (MK) repair only (MKo); Group 2, MK repair plus Tri-C (MK ​+ ​Tri-C); and Group 3, MK repair plus an additional outside knot plus Tri-C (MK-2knots ​+ ​Tri-C). Mechanical evaluations were performed for all groups. ResultsThe frictions of the two groups with Tri-C were not significantly different than those of the MKo group. The ultimate tensile strength of the MK ​+ ​Tri-C group was not significantly different from that of the MKo group or the MK-2knots ​+ ​Tri-C group. In contrast, the MK-2knots ​+ ​Tri-C group had a significantly greater ultimate tensile strength compared with that of the MKo group. Forces at 2-mm gap formation in the groups with Tri-C were significantly stronger than that of MK alone. ConclusionOur data have demonstrated that MK repair augmented with the centre hollow mesh suture increased failure strength without inducing increased friction. The translational potential of this articleOur study elucidates that a Tri-C augmentation designed in this study can achieve mechanical enhancements without increasing the repaired tendon friction. Hence, this novel technique has potential biological validity and clinical application.