The tensile strengths of various suture techniques were studied in vitro using rabbit Achilles' and flexor digitorum longus tendons. Two new suture methods, a Double and Triple (modified) Kessler, were compared with the Savage, Indiana and modified Kessler techniques. All were core sutures without epitendinous sutures. All suture techniques were found to be significantly different for 2 mm of gap formation. The study found the Savage technique strongest, followed by the Triple Kessler, the Double Kessler, and finally the Indiana. The Double Kessler was almost twice as strong as the modified Kessler. This study also compared two four-stranded techniques (the Indiana and Double Kessler) and found the Double Kessler stronger. The Double Kessler is a simple yet strong suture and may be useful for flexor tendon repairs.

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