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Abstract

We thank Solomons1Solomons M.W. Letter regarding “Comparison of flexor tendon suture techniques including 1 using 10 strands.”.J Hand Surg Am. 2016; Google Scholar for his interest in our study. First of all, we applied the 4-strand cruciate repair technique as described in McLarney et al.2McLarney E. Hoffman H. Wolfe S.W. Biomechanical analysis of the cruciate four-strand flexor tendon repair.J Hand Surg Am. 1999; 24: 295-301Abstract Full Text Full Text PDF PubMed Scopus (161) Google Scholar This method is grasping, not locking, which is weaker than the cross-lock method as mentioned by Solomons. It was our mistake to describe this technique as locking cruciate. Although it was described as a simple lock suture in some article,3Croog A. Goldstein R. Nasser P. Lee S.K. Comparative biomechanic performances of locked cruciate four-strand flexor tendon repairs in an ex vivo porcine model.J Hand Surg Am. 2007; 32: 225-232Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar we agree that this technique is grasping suture rather than locking suture. Thus we correct the technique used in our article as “4-strand nonlocked cruciate suture technique.”4Lee H.I. Lee J.S. Kim T.H. Chang S.H. Park M.J. Lee G.J. Comparison of flexor tendon suture techniques including 1 using 10 strands.J Hand Surg Am. 2015; 40: 1369-1376Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar The more proper name for locked cruciate repair mentioned by Solomons might be cross-lock 4-strand cruciate suture and it is also called the Adelaide suture.5Sandow M.J. McMahon M. Active mobilisation following single cross grasp four-strand flexor tenorrhaphy (Adelaide repair).J Hand Surg Eur Vol. 2011; 36: 467-475Crossref PubMed Scopus (47) Google Scholar Solomons also mentioned that the biomechanics strength of the cross-lock 4-strand cruciate technique is even greater than that of the 10-strand repair technique. However, a direct comparison of experimental values between 2 different studies is difficult. Actual experimental results depend on various factors such as suture material, suture caliber, and the kind of peripheral suture. We could find that the 2-mm gap strength of the same simple nonlocking cruciate technique was not similar in 2 different experimental conditions (75 N in Croog et al3Croog A. Goldstein R. Nasser P. Lee S.K. Comparative biomechanic performances of locked cruciate four-strand flexor tendon repairs in an ex vivo porcine model.J Hand Surg Am. 2007; 32: 225-232Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar vs 26 N in Lee et al4Lee H.I. Lee J.S. Kim T.H. Chang S.H. Park M.J. Lee G.J. Comparison of flexor tendon suture techniques including 1 using 10 strands.J Hand Surg Am. 2015; 40: 1369-1376Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar). There is 3 times strength gap between 2 same suture techniques depending on the experimental condition. Suture material might have a critical role in this discrepancy between 2 experimental conditions. 3-0 Fiber-wire was used in the study of Croog et al, which is much stronger than 4-0 nylon we used. We hope to directly compare cross-locking 4-strand cruciate repair with our technique in near future. Nevertheless, we agree with the author’s opinion that the cross-lock 4-strand cruciate repair technique is biomechanically sound and easy to perform. Letter Regarding “Comparison of Flexor Tendon Suture Techniques Including 1 Using 10 Strands”Journal of Hand SurgeryVol. 41Issue 2PreviewI read with interest the paper by Lee et al1 regarding a 10-strand suture technique. Full-Text PDF