Biomechanical study of a newly developed continuous double knots technique compared with the 4-strand double-modified Kessler technique for flexor tendon repair

Abstract

Purpose In this study we compare the biomechanical properties of a novel suture technique that we developed called the continuous double knots technique for repairing flexor tendon injuries with the standard 4-strand double-modified Kessler technique. Methods This was an experimental study. Eighty porcine flexor digitorum profundus tendons were harvested and divided randomly into two groups of 40. The first group (N = 40) was repaired using the 4-strand double modified Kessler technique and the second group (N = 40) was repaired using our new continuous double knots technique. The two groups were randomly divided and the ultimate failure load (n = 20) and cyclic testing to failure (n = 20) were compared. Results The mean ultimate failure load was 25.90 ± 7.11 (N) and cyclic testing to failure 88 ± 47.87 (cycles) for the 4-strand double modified Kessler technique and 34.56 ± 6.60 (N) and 189 ± 66.36 (cycles) for our new continuous double knots technique. The T-test revealed a significant difference between the 2 techniques (p < 0.05). In terms of biomechanical properties in tendon repair, the continuous double knots technique group had a higher tensile strength than the 4-strand double-modified Kessler technique group. There were also significant differences between the ultimate failure load and cyclic testing to failure for the flexor tendon sutures. Conclusions The continuous double knots technique suture technique had significantly higher maximum tensile strength and cyclic testing than the 4-strand double modified Kessler technique in an in vitro study, and in thus an optional technique for flexor tendon repair.

Contributing factors to hand flexor tendon rerupture

“…The modified Kessler method is commonly used for flexor tendon repair [14,15]. In addition, we frequently use the loop suture technique in our practice.…”

“…The four-strand core suture is the most frequently used among two-, four-, six-, and eight-strand core sutures [14]. Although tendon strength increases with the number of core strands [17], a low number of strands in the initial tendon repair was not a risk factor for rerupture.…”