Abstract
The failure rate of intrasynovial tendon repair is high due to substantial elongation at the repair site and to the development of adhesions between the tendon’s surface and the surrounding digital sheath. To minimize these complications, we sought to reduce the incidence of gapping and to facilitate the initiation of early motion by improving the time zero structural properties of repair. The Winters-Gelberman 8-strand repair technique was modified by adding surface lock loops and by using Fiberwire suture material. Forty-eight canine flexor digitorum profundus tendons were transected and repaired with one of three 8-strand techniques (Pennington modified Kessler, half hitch loops, or surface locking Kessler) using either 3–0 Supramid or 4–0 Fiberwire suture. Biomechanical testing was performed to determine the physiologic and failure mode properties of the repairs. The surface locking Kessler technique improved repair maximum load, load necessary to create a 2 mm repair site gap, and yield force compared to the modified Kessler and half hitch loop techniques. Fiberwire suture improved maximum load, the load necessary to create a 2 mm repair site gap, stiffness, and yield force compared to Supramid suture. Failure occurred by both suture pull out and by suture breakage in the modified Kessler, Supramid suture repair group. Failure occurred consistently by suture breakage in the surface locking Kessler, Supramid suture repair group. These results reveal that a novel locking Kessler repair is significantly stronger than the current state-of-the art flexor tendon suture repair technique. The use of a surface locking Kessler technique with Fiberwire suture markedly improves the mechanical properties of intrasynovial tendon repair by reducing the risk of post-operative gapping and rupture.
Highlights
The outcomes of intrasynovial flexor tendon repair are highly variable due to the frequent occurrence of repair site elongation and catastrophic rupture and due to adhesion formation between the tendon and its surrounding digital sheath [1,2]
All of the hitch loop technique (HHL) and surface locking Kessler (SLK) repairs with Supramid suture failed by suture breakage except one, which failed by suture pullout
The SLK repairs with Fiberwire had the highest maximum load (Fig 3)
Summary
The outcomes of intrasynovial flexor tendon repair are highly variable due to the frequent occurrence of repair site elongation and catastrophic rupture and due to adhesion formation between the tendon and its surrounding digital sheath [1,2]. Two approaches have been employed to reduce the incidence of these complications: improved techniques for repairing tendon to reduce gap formation and rupture, and early controlled motion rehabilitation to prevent adhesion formation. The objective of the current ex vivo study was to explore a method for improving the initial structural properties of intrasynovial tendon repair, thereby reducing the incidence of gap formation in the early stages following tendon suture. In vivo animal studies indicate that, under conditions of early controlled mobilization, the strength values achieved at time zero persist throughout the initial four weeks post repair [3]. The achievement of a stiff and strong initial repair is of critical importance to the initiation of early controlled mobilization and to achieving longer term positive clinical outcomes
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