Eight-strand Cross-locked Cruciate Flexor Tendon Repair Using Double-stranded Suture: A Description of the Surgical Technique

Watanabe, Kentaro; Ota, Hideyuki; Sasaki, Hiroshi

doi:10.1097/gox.0000000000001048

Cited by 7 publications

(7 citation statements)

References 7 publications

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“…The sixstrand modified Savage technique and eight-strand crosslocked cruciate repair require more needle reversal than Yoshizu cross-lock repair. 4,14 The load to a 2-mm gap is used to measure clinical failure because gaps larger than 2 mm have been associated with significant deteriorations in patient outcomes (caused by adhesions). 17, 18 Urbaniak et al reported that active flexion under mild resistance can impart a force of 10 N; this increases to 17 N when resistance is moderate.…”

Section: Discussionmentioning

confidence: 99%

“…The six-strand modified Savage technique and eight-strand cross-locked cruciate repair require more needle reversal than Yoshizu cross-lock repair. 4 14…”

Section: Discussionmentioning

confidence: 99%

“…A cross-lock theoretically requires more suture passes compared with other locking configurations, such as the Tsuge and modified Kessler configurations. 15 16 When limited to a multistrand technique using cross-lock configurations, eight-strand cross-locked cruciate repair requires 12 suture passes for the complete suture, 14 compared with 18 suture passes with the six-strand-based modified Savage technique. 4 The Yoshizu cross-lock suture is an eight-strand suture; however, there are only two grasps on either side.…”

Section: Discussionmentioning

confidence: 99%

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Biomechanical Analysis of a New Eight-Strand Suture for Flexor Tendon Repair

Moriya¹,

Maki²,

Koda³

et al. 2022

Indian J Plast Surg

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Background The placement of multistrand sutures during flexor tendon repair requires complicated surgical skills; such suturing is difficult. We developed a new, simpler eight-strand suture, which we term the Yoshizu cross-lock. This reduces the numbers of suture passages through the tendons, as well as the numbers of knots. Methods Fourteen porcine flexor tendons were transected and repaired using the Yoshizu cross-lock system; no peripheral sutures were placed. Our system is a modification of the published, exposed cross-lock repair method that employs a 4–0 monofilament nylon two-strand line and two needles. The repaired tendons were subjected to linear, noncyclic load-to-failure tensile testing. The initial gap, the 2-mm gap force, and the ultimate strength were measured. Results The initial gap force was 12.6 ± 5.6 Newtons (N), the 2-mm gap force was 33.9 ± 10.9 N, and the ultimate strength was 70.1 ± 17.0 N. All tendons subjected to Yoshizu cross-lock repair failed due to suture rupture rather than pullout. Conclusions Our biomechanical study revealed that Yoshizu cross-lock repair had sufficient tensile strength but was associated with wide variation in the 2-mm gap load (standard deviation = 10.9 N). This study is clinically relevant, showing that the Yoshizu cross-lock repair combined with peripheral suturing may allow a repaired flexor tendon to withstand the stresses encountered during early active mobilization. This simple eight-strand technique will be particularly useful to surgeons who commonly employ the cross-lock stitch for primary flexor tendon repair following early mobilization.

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Section: Discussionmentioning

confidence: 99%

“…The six-strand modified Savage technique and eight-strand cross-locked cruciate repair require more needle reversal than Yoshizu cross-lock repair. 4 14…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Biomechanical Analysis of a New Eight-Strand Suture for Flexor Tendon Repair

Moriya¹,

Maki²,

Koda³

et al. 2022

Indian J Plast Surg

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“…Therefore, other 8-strand tendon repair techniques were introduced, such as the new half-hitch loop suture, 27 surface locking Kessler techniques, 28 and 8-strand cross-locked cruciate repair using a double-stranded suture. 29 Despite several biomechanical studies, there are no reports that detail clinical outcomes using 8-strand sutures and early active mobilization. These techniques have relatively complex configurations.…”

Section: Discussionmentioning

confidence: 99%

Effects of Different Core Suture Lengths on Tensile Strength of Multiple-Strand Sutures for Flexor Tendon Repair

Chinen

Ōkubo

Kusano

et al. 2021

Journal of Hand Surgery Global Online

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Purpose: To compare 2 types of newly devised 8-strand quadruple-looped suture (QLS) techniques with a 6-strand triple-looped suture (TLS) technique; and to assess the effects of different core suture lengths (CSLs) (the length between 2 locking sites of a suture strand) within each suture row on tensile strength. Methods: We repaired 24 flexor tendons from 12 rabbits using the TLS and QLS techniques, with equal CSL (QLS) or unequal CSL (unequal QLS) among each suture row. The QLS was composed of 4 looped sutures on the anterolateral and posterolateral aspects of the tendon. The cross-sectional area of the locking portion of each thread in the QLS was equal to that in the TLS. In the QLS technique, the CSL on each aspect of the tendon was 13 mm. In the unequal QLS technique, the CSL on each aspect of the tendon was 13 and 17 mm. The load at 1-and 2-mm gaps, the maximum load until the 3-mm gap, and the ultimate load were compared among the 3 techniques. Results: The QLS was significantly stronger than the unequal QLS and the TLS for loads at 1-mm and 2mm gaps, maximum load until 3-mm gap, and ultimate load. There was no significant difference between the unequal QLS and TLS techniques. The QLS technique showed an approximately 30% increase in gap resistance and ultimate strength compared with the TLS technique. Conclusions: The QLS technique showed an estimated increase in tensile strength proportional to the number of suture strands compared with the TLS technique. Our study suggests that a consistent CSL in each suture row provides the highest strength in multistrand sutures consisting of the same configuration of suture rows. Clinical relevance: The QLS technique may reduce the risk for tendon rupture associated with early active mobilization after flexor tendon repair.

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“… 13 – 17 Additionally, to maximize the success of tendon repair, it is generally recommended that a locking technique be used rather than a grasping technique. 18 – 21 The extremes of these principles have even led to the development of steel devices 22 and use of 8-stranded repair techniques, 14 which demonstrate a predictable increase in strength during ex vivo testing. While such techniques may increase strength, it is often done so at the cost of additional bulk and introduction of more foreign material into the body.…”

Section: Introductionmentioning

confidence: 99%

Beyond the Core Suture: A New Approach to Tendon Repair

Zeng

Albano

Sanchez

et al. 2020

Plastic and Reconstructive Surgery - Global Open

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Background: Despite significant improvements in zone II flexor tendon repair over the last 2 decades, function-limiting complications persist. This article describes 2 novel repair techniques utilizing flexor digitorum superficialis (FDS) autografts to buttress the flexor digitorum profundus (FDP) repair site without the use of core sutures. The hypothesis being that the reclaimed FDS tendon autograft will redistribute tensile forces away from the FDP repair site, increasing overall strength and resistance to gapping in Zone II flexor tendon injuries compared with the current clinical techniques. Methods: Two novel FDP repair methods utilizing portions of FDS have been described: (1) asymmetric repair (AR), and (2) circumferential repair. Ultimate tensile strength and cyclical testing were used to compare novel techniques to current clinical standard repairs: 2-strand (2-St), 4-strand (4-St), and 6-strand (6-St) methods. All repairs were performed in cadaveric sheep tendons (n = 10/group), by a single surgeon. Results: AR and circumferential repair techniques demonstrated comparable ultimate tensile strength to 6-St repairs, with all 3 of these techniques able to tolerate significantly stronger loads than the 2-St and 4-St repairs (P < 0.0001). Cyclical testing demonstrated that AR and circumferential repair were able to withstand a significantly higher total cumulative force (P < 0.001 and P = 0.0064, respectively) than the 6-St, while only AR tolerated a significantly greater force to 2-mm gap formation (P = 0.042) than the 6-St repair. Conclusion: Incorporating FDS as an autologous graft for FDP repair provides at least a comparable ultimate tensile strength and a significantly greater cumulative force to failure and 2-mm gap formation than a traditional 6-St repair.

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Eight-strand Cross-locked Cruciate Flexor Tendon Repair Using Double-stranded Suture: A Description of the Surgical Technique

Cited by 7 publications

References 7 publications

Biomechanical Analysis of a New Eight-Strand Suture for Flexor Tendon Repair

Biomechanical Analysis of a New Eight-Strand Suture for Flexor Tendon Repair

Effects of Different Core Suture Lengths on Tensile Strength of Multiple-Strand Sutures for Flexor Tendon Repair

Beyond the Core Suture: A New Approach to Tendon Repair

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