The Effect of Epitendinous Suture Technique on Gliding Resistance During Cyclic Motion After Flexor Tendon Repair: A Cadaveric Study

Tamami Moriya, Chunfeng Zhao, Kai Nan An, Peter C. Amadio

Research output: Contribution to journalArticlepeer-review

31 Scopus citations

Abstract

Purpose: To investigate the effects of motion following repair with a modified Kessler core suture and 5 different epitendinous suture designs on the gliding resistance, breaking strength, 2-mm gap force, and stiffness of flexor digitorum profundus tendons in a human in vitro model. Methods: The flexor digitorum profundus tendons of the index, middle, ring, and little fingers of 50 human cadavers were transected and repaired with a 2-strand modified Kessler suture and assigned to 5 groups based on type of epitendinous suture design. The 5 epitendinous designs tested were a simple, running epitendinous suture whose knot was outside the repair (simple running KO); a simple, running epitendinous suture whose knot was inside the repair (simple running KI); a cross-stitch epitendinous suture; an interlocking, horizontal mattress (IHM) epitendinous suture; and a running-locking epitendinous suture. The tendon repair strength and 2-mm gap force were measured after 1,000 cycles of tendon motion. The resistance to gap formation, a measure of repair stiffness, was obtained from the force versus gap data. Results: None of the repairs showed any gap formation after 1,000 cycles of tendon motion. The cross-stitch epitendinous suture, IHM epitendinous suture, and running-locking epitendinous suture all had significantly lower gliding resistance than the simple running KO epitendinous suture after 1 cycle. The simple running KI epitendinous suture had significantly lower gliding resistance than the simple running KO epitendinous suture after 100 cycles and 1,000 cycles. The differences for gap force at 2 mm and stiffness of the repaired tendon evaluation were not statistically significant. The cross-stitch epitendinous suture, IHM epitendinous suture, and running-locking epitendinous suture all had significantly higher maximal failure strength after 1,000 cycles than the simple running KI epitendinous suture. Conclusions: The cross-stitch, IHM, and running-locking epitendinous sutures had the best combination of higher strength and lower gliding resistance in this study. Although these findings suggest a potential for these suture types to be preferred as epitendinous sutures, these repairs should first be investigated in vivo to address their effect on tendon healing and adhesion formation.

Original languageEnglish (US)
Pages (from-to)552-558
Number of pages7
JournalJournal of Hand Surgery
Volume35
Issue number4
DOIs
StatePublished - Apr 2010

Keywords

  • Epitendinous suture
  • gliding resistance
  • suture
  • tendon
  • tendon repair

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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