Article
Development and biomechanical analysis of a new 4-strand suture for transosseous flexor tendon repairs in zone 1
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Authors
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Patrick Harenberg
- Department of Plastic Surgery, Burn Centre, Hand Surgery Centre, University Hospital Bochum, Bochum, Germany
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Jörg Grünert
- Department of Hand, Plastic and Reconstructive Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
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Marcus Lehnhardt
- Department of Plastic Surgery, Burn Centre, Hand Surgery Centre, University Hospital Bochum, Bochum, Germany
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Samuel Christen
- Department of Hand, Plastic and Reconstructive Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| Published: | February 6, 2020 |
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Outline
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Objectives/Interrogation: Development of a transosseous suture for zone 1 repairs that can withstand immediate controlled active motion rehabilitation.
Methods: 30 deep flexor tendons and distal phalanges were harvested from pigs feet. Tendons were cut perpendicular at the joint line. Tendons were randomly assigned to one of three groups: (1) A hole was drilled through the base of the distal phalanx in a coronar plane. A 18G hypodermic needle was passed through the drill hole. Two additional needles were passed from the tendon insertion to the lateral ends of the drill canal. A 3-0 PDS suture is passed through the needles with successive removal of the needles. An unarmed needle is placed at the free end of the suture. The tendon is sutured to the bone in a Krackow-like technique. (2) like (1) but two additional epitendinous figure-of-eight stitches with 5-0 PDS are placed, (3) Only the needle through the drill hole is used. The end of a 4-0 Supramid loop is passed through the needle and the needle is removed. A second supramid loop is threaded through the already placed loop, linking them. The needles at both ends are passed to the tendon insertion. The tendon is first sutured to the bone in a Zechner-like technique and the knot is pulled tight. Two additional Krackow-like locking loops are performed at each side of the repair. Placement of an epitendinous suture like in (2).
Completed repairs were fixed in a biomechanical testing machine, a 1N preload was applied followed by distraction at a rate of 1 cm/min. During distraction, photos in two planes were recorded together with distraction and applied force. For statistical analysis force at a 2 mm gap in the repair (2GF) and ultimate failure load (UFL) were recorded. Tamhane's T2-test was used for group comparisons during statistical analysis.
Results and Conclusions: Mean 2GF was 6.4N for group 1, 23.2N for group 2 and 52.8N for group 3. Differences were significant at p<0.001 between all groups. Mean UFL was 55.6N for group 1, 53.2N for group 2 and 63.3N for group 3. No statistically significant differences were detected. No suture pull-outs occurred. No common suture breaking point was noted at UFL.
Addition of two epitendinous stitches significantly improves 2GF in zone 1 repairs. Furthermore, the presented 4-strand technique can withstand enough force to allow for immediate controlled active motion rehabilitation.
