TY - JOUR
T1 - Gliding Characteristics and Gap Formation for Locking and Grasping Tendon Repairs
T2 - A Biomechanical Study in a Human Cadaver Model
AU - Tanaka, Tatsuro
AU - Amadio, Peter C.
AU - Zhao, Chunfeng
AU - Zobitz, Mark E.
AU - Yang, Chao
AU - An, Kai Nan
N1 - Funding Information:
This study was supported by grant #44391, awarded by the National Institutes of Health (NIAMS).
PY - 2004/1
Y1 - 2004/1
N2 - Purpose: The purpose of this study was to compare the frictional characteristics and mechanical properties of various locking and grasping suture techniques in a human in vitro model of flexor tendon repair. Methods: Forty-five cadaveric human flexor digitorum profundus tendons were transected in zone II and repaired using 1 of 5 core suture methods (n = 9 per group): either grasping (modified grasping Kessler, modified Lee) or locking (Pennington, modified Pennington, locking Lee) loop suture techniques. All repairs used 4-0 Supramid looped core suture and an epitenon running suture of 6-0 nylon. Gliding resistance at the tendon-pulley interface was measured along with failure strength and gap formation. The force to produce 0.5-, 1.0-, 1.5-, and 2.0-mm gaps were measured. Results: One of the locking repairs, the locking Lee, had a gliding resistance significantly higher than that of one of the grasping repairs (modified grasping Kessler) and the other 2 locking repairs (Pennington, modified Pennington) (p < .05). There was no significant difference between the other grasping (modified Kessler, modified Lee) and locking (Pennington, modified Pennington) suture configurations (p = .21). The maximum force of one of the locking repairs, the modified Pennington repair (48.0 N; standard deviation, 3.9) was significantly higher than the other locking and grasping repairs (p < .05). The force required to produce more than 1.5 mm of gap for the modified Pennington repair was also significantly higher than that for some of the other grasping (modified Kessler, modified Lee) and locking (Pennington) repairs (p < .05). Conclusions: The lack of significant difference in gliding resistance among the similarly designed modified grasping Kessler, Pennington, and modified Pennington repairs (overall mean, 0.87 N; standard deviation, 0.16) suggests that the locking loop configuration itself does not adversely affect tendon gliding resistance. The modified Pennington repair increased not only ultimate strength but also resistance to gap formation more than 1.5 mm.
AB - Purpose: The purpose of this study was to compare the frictional characteristics and mechanical properties of various locking and grasping suture techniques in a human in vitro model of flexor tendon repair. Methods: Forty-five cadaveric human flexor digitorum profundus tendons were transected in zone II and repaired using 1 of 5 core suture methods (n = 9 per group): either grasping (modified grasping Kessler, modified Lee) or locking (Pennington, modified Pennington, locking Lee) loop suture techniques. All repairs used 4-0 Supramid looped core suture and an epitenon running suture of 6-0 nylon. Gliding resistance at the tendon-pulley interface was measured along with failure strength and gap formation. The force to produce 0.5-, 1.0-, 1.5-, and 2.0-mm gaps were measured. Results: One of the locking repairs, the locking Lee, had a gliding resistance significantly higher than that of one of the grasping repairs (modified grasping Kessler) and the other 2 locking repairs (Pennington, modified Pennington) (p < .05). There was no significant difference between the other grasping (modified Kessler, modified Lee) and locking (Pennington, modified Pennington) suture configurations (p = .21). The maximum force of one of the locking repairs, the modified Pennington repair (48.0 N; standard deviation, 3.9) was significantly higher than the other locking and grasping repairs (p < .05). The force required to produce more than 1.5 mm of gap for the modified Pennington repair was also significantly higher than that for some of the other grasping (modified Kessler, modified Lee) and locking (Pennington) repairs (p < .05). Conclusions: The lack of significant difference in gliding resistance among the similarly designed modified grasping Kessler, Pennington, and modified Pennington repairs (overall mean, 0.87 N; standard deviation, 0.16) suggests that the locking loop configuration itself does not adversely affect tendon gliding resistance. The modified Pennington repair increased not only ultimate strength but also resistance to gap formation more than 1.5 mm.
KW - Flexor tendon
KW - Gliding resistance
KW - Locking suture
KW - Tendon repair
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U2 - 10.1016/j.jhsa.2003.09.017
DO - 10.1016/j.jhsa.2003.09.017
M3 - Article
C2 - 14751096
AN - SCOPUS:0742305398
SN - 0363-5023
VL - 29
SP - 6
EP - 14
JO - Journal of Hand Surgery
JF - Journal of Hand Surgery
IS - 1
ER -