A Biomechanical Comparison of 3 Loop Suture Materials in a 6-Strand Flexor Tendon Repair Technique

Biomechanical Evaluation of 4-Strand Flexor Tendon Repair Techniques, Including a Combined Kessler–Tsuge Approach

“…Many authors avoid the epitendinous suture in biomechanical testing to eliminate confounding variables. 20,23 The epitendinous suture is valuable because it supports the core suture, especially at a tensile range of 2 to 9 N, which occurs during active motion without resistance, and at a tensile range of 8 to 35 N, which occurs during active motion with light resistance. 19 Nevertheless, some of the means in group 2 (with an epitendinous suture) were below those in group 1.…”

“…We chose porcine forelimbs flexor tendons for this study because they were readily available and cost-effective and have been shown to offer a comparable model for human tendons for the study of flexor tendon repair. 23,24 We harvested and randomized 47 fresh porcine flexor tendons from the central 2 rays of the forefeet. All tendons were continuously stored in saline solutionesoaked gauze compress pouches to preserve the tissue uniformly.…”

“…It is therefore preferable to create multiple-strand suture patterns with fewer suture passages and no knots on the tendon surface. 22 Our aim was to design a looped technique that followed 4 principles: a 4-strand technique using FiberWire (Arthrex, Inc), because this suture material has superior ultimate strength and pull-out versus other suture materials 23 ; no bulky knots in the repair site, which may improve healing; no bulky knots on the tendon surface, which could improve tendon sliding; and a suture that crosses the repair site only twice, which could make accurate coaptation with an atraumatic technique easier.…”

Conceptos Biomecánicos de las Suturas Tendinosas

“…17 Se han llegado a publicar fuerzas de hasta 124N cuando se ha utilizado el loop de FiberWire (Arthrex, Naples, FL) en la sutura Lim-Tsai modificada de 6 hebras. 19 Pero el FiberWire (Arthrex, Naples, FL) no está exento de problemas, ya que presenta un diámetro mayor que la misma categoría que otras suturas lo que significa que si medimos la resistencia de la sutura en proporción a su área transversal, esta sólo sea un 10% más fuerte que el Ticron (Syneture, Norwalk, CT, USA), 20 además su dificultad para obtener un anudado seguro ha provocado la aparición de estudios que analizan la configuración del nudo y su resistencia en ese tipo de sutura. [21][22][23] Tal es así que cuando se comparan Ethibond, Ethilon, Surgilon y PDS II y se utiliza un anudado quirúrgico habitual, Surgilon (multifilamento de Nylon), presenta una mayor resistencia a la rotura, en cambio, cuando la sutura se realiza con 4 bucles adicionales al anudado habitual, FiberWire (Arthrex, Naples, FL) presenta la mayor resistencia.…”

Re: Le et al. Number of suture throws and its impact on the biomechanical properties of the four-strand cruciate locked flexor tendon repair with FiberWire. J Hand Surg Eur. 2012, 37: 826–31

“…When there appears to be a potential problem of triggering, the knot may be tucked into the tendon through a small longitudinal incision, at approximately 1 cm from the repair site. FiberWire is used widely (Gan et al, 2012;Haimovici et al, 2012;McDonald et al, 2012;Petri et al, 2012). While most studies using FiberWire are in vitro, it underscores the fact that there is wide acceptance of its use in tendon repairs.…”