The strengths of one-, two-, and three-weave Pulvertaft tendon repairs

Abstract

We tested the tensile strength of the proximal juncture of tendon grafts with Pulvertaft tendon repairs in 18 cadaveric digital flexor tendons. These tendons were divided into three groups of six: single, two, or three weaves. Each of the interlacing weaves was secured with eight anchoring sutures. The specimens were loaded in a biomechanical tester until failure. The ultimate tensile strength did not show any significant differences across all three groups with statistical power of 0.77. The mean tendon elongation before repair failure showed significant difference at 10 mm (standard deviation (SD) 2), 16 mm (SD 3), and 15 mm (SD 3), respectively. All specimens failed by intra-tendinous pull-out of the weaves. We conclude that the two-weave Pulvertaft construct demonstrated comparable tensile strength to three weaves and tendon elongation was similar when two or three weaves were used.

Letter about a published paper

“…Dear Editor, We thank Mr Hems for his comments on our articles. In our first article (Choke et al, 2020), we emphasized that our main focus was on the effect of weaves and thus we had to control all other factors, namely suture material and repair configuration. We found that two-weave Pulvertaft is sufficient to provide adequate repair strength (91 N) and ease the complexity of surgery due to the additional weave and increased number of sutures that add to the bulk of the repair.…”

“…The first study by Choke et al (2020) investigates the effect of the number of weaves on the initial tensile strength of the repair by comparing one, two and three weaves. The results suggest that the twoweave repair had similar tensile strength (91 N) to the three-weave repair (89 N).…”

Alternative Tendon Coaptations to the Pulvertaft Weave Technique: A Systematic Review and Meta-Analysis of Biomechanical Studies

“…It is commonly used during upper extremity reconstruction when end-to-end tendon repairs and nerve transfers are not possible. 2-4 As the PT conveys significant strength, it will likely continue in clinical practice. 5-7…”

The strengths of four different suture types in Pulvertaft tendon reconstruction

“…The strengths of four different suture types in Pulvertaft tendon reconstruction Dear Editor, In our previous article 'A biomechanical study of strengths of one-, two-, or three-weave Pulvertaft tendon repair' (Choke et al, 2020), we ascertained that the two-weave Pulvertaft repair is a satisfactory choice for tendon reconstruction. Following on from that study, we wanted to evaluate if suture type had any effect on the Pulvertaft tendon construct.…”

“…Each flexor tendon was divided into two separate lengths, where one end was made a donor tendon and another end was made a recipient tendon, in order to control for tendon dimensions. The Pulvertaft weave was constructed, two-weaves secured with eight sutures (simple sutures), with the same technique as previously described (Choke et al, 2020). The same biomechanical testing protocol was used to measure the ultimate tensile strength and tendon elongation at maximum load.…”