Restricted accessResearch articleFirst published online 2010-1
Strength enhancement of the interlocking mechanism in cross-stitch peripheral sutures for flexor tendon repair: biomechanical comparisons by cyclic loading
The fatigue strength of three peripheral suture techniques for flexor tendon repair was compared by cyclic loading of repairs in a cotton dental roll tendon model. Thirty pairs of dental roll were sutured using only peripheral sutures with 6-0 polypropylene. An initial cyclic load of 5 N for 500 cycles was applied and increased by 5 N for an additional 500 cycles at each new load until rupture. The fatigue strength of an interlocking cross-stitch suture was 113% greater than a running suture and 36% greater than a standard cross-stitch suture. Interlocking the cross-stitch prevented shortening of the transverse portions under load and appears to be a useful technique for increasing the strength of the peripheral suture.
BarrieKATomakSLCholewickiJWolfeSW. The role of multiple strands and locking sutures on gap formation of flexor tendon repairs during cyclical loading. J Hand Surg Am. 2000, 25: 714–20.
2.
ChouekaJHemingerHMassDP. Cyclical testing of zone 2 flexor tendon repair. J Hand Surg Am. 2000, 25: 1127–34.
3.
DiaoEHariharanJSSoejimaOLotzJC. Effect of peripheral suture depth on strength of tendon repairs. J Hand Surg Am. 1996, 21: 234–9.
4.
DonaETurnerAWLGianoutsosMPWalshWR. Biomechanical properties of four circumferential flexor tendon suture techniques. J Hand Surg Am. 2003, 28: 824–31.
5.
GreenwaldDPHongHZMayJW. Mechanical analysis of tendon suture techniques. J Hand Surg Am. 1994, 19: 641–7.
6.
KimPTAokiMTokitaFIshiiS. Tensile strength of cross-stitch epitenon suture. J Hand Surg Br. 1996, 21: 821–3.
7.
KubotaHAokiMPruittDLManskePR. Mechanical properties of various circumferential tendon suture techniques. J Hand Surg Br. 1996, 21: 474–80.
8.
LeddyJP. Flexor tendon-acute injuries. In: GreenDP (ED.) Operative hand surgery. 3rd Edn. Vol 2. New York, Churchill Livingstone, 1993: 1823–51.
9.
ManchioJVShashikantMPShrivastavaAWeinzweigJVernadakisAJ. Evaluation of a new 4-strand flexor tendon repair in a cadaveric porcine model. J Hand Surg Am. 2009, 34: 102–7.
10.
MishraVKuiperJHKellyCP. Influence of core suture material and peripheral repair technique on the strength of Kessler flexor tendon repair. J Hand Surg Br. 2003, 28: 357–62.
11.
SandersDWMilneADDobravecAMacdermidJJohnsonJAKingGJW. Cyclic testing of flexor tendon repairs: an in vitro biomechanical study. J Hand Surg Am. 1997, 22: 1004–10.
12.
SilfverskiöldKLAnderssonCH. Two new methods of tendon repair: an in vitro evaluation of tensile strength and gap formation. J Hand Surg Am. 1993, 18: 58–65.
13.
SilfverskiöldKLMayEJ. Flexor tendon repair in zone 2 with a new suture technique and an early mobilization program combining passive and active flexion. J Hand Surg Am. 1994, 19: 53–60.
14.
StricklandJW. Flexor tendon injuries: 1. Foundations of treatment. J Am Acad Orthop Surg. 1995, 3: 44–54.
15.
TangJB. Indication, methods, postoperative motion and outcome evaluation of primary flexor tendon repairs in zone 2. J Hand Surg Br. 2007, 32: 118–29.
TareM. Dental rolls: a suitable model for practising tendon repair techniques. J Hand Surg Br. 2004, 29: 506–7.
18.
TranHNCannonDLLieberRLAbramsRA. In vitro cyclic tensile testing of combined peripheral and core flexor tenorrhaphy suture techniques. J Hand Surg Am. 2002, 27: 518–24.
19.
WadePJFMuirIFKHutcheonLL. Primary flexor tendon repair: the mechanical limitations of the modified Kessler technique. J Hand Surg Br. 1986, 11: 71–6.
20.
WangBTangJB. Embedded cross-stitch suture: an alternative to current cross-stitch peripheral suture. J Hand Surg Br. 2003, 28: 471–4.
21.
WilliamsRJNAmisAA. A new type of flexor tendon repair: biomechanical evaluation by cyclic loading, ultimate strength and assessment of pulley friction in vitro. J Hand Surg Br. 1995, 20: 578–83.
