The Locking Loop Tendon Suture

Optimizing biomechanical performance of the 4-strand cruciate flexor tendon repair

“…It is a 2-strand repair with 2 lateral grasping components on each side of the tendon division. Pennington 23 described the "locking" loop modification of the Kessler repair whereby the transverse component of the suture passed volar to the longitudinal strands, thus locking onto a bundle of tendon fibers when the tendon was subject to tensile forces. This is in contrast to grasping configurations in which the transverse component passed dorsal to the longitudinal strands, therefore making it unable to hold onto the tendon firmly when subjected to tensile forces.…”

“…Similar to the 2-strand Kessler technique 22 the cruciate repair can incorporate either a grasping or locking loop configuration at each corner. Pennington 23 introduced the concept of a locking loop with his work on the Kessler method. He noted that if the transverse component of the suture passed volar to the longitudinal strand it would lock onto those fibers it encompassed.…”

Gliding characteristics and gap formation for locking and grasping tendon repairs: a biomechanical study in a human cadaver model

“…The most popular means of improving repair strength has been increasing the number of suture strands across the repair site, because there is a linear relationship between the number of the suture strands across the repair site and tensile strength. 20 -24 There is debate, [25][26][27][28][29][30] however, as to whether the suture loop configuration-grasping or locking-increases the pullout strength of the suture.…”

Suture techniques with high breaking strength and low gliding resistance: Experiments in the dog flexor digitorum profundus tendon

“…The classic Kessler method has also continued to be modi ed. The original Kessler method has two knots outside the repair site, while the modi ed Kessler method incorporates the knot within the repair site (Pennington 1979). The Tajima (1984) suture method is similar to the modi ed Kessler, with two knots inside the repair site.…”