Abstract
Kessler, Strickland, or modified Becker repairs, all augmented with a running circumferential
epitenon suture, were performed for simulated zone II flexor tendon lacerations in
the index, long, and ring fingers of 12 fresh-frozen cadaveric specimens. Each hand
was tested with a tensiometer built for curvilinear testing of human flexor tendons
in an intact hand. Each tendon was cycled 100 times, then examined for gapping before
testing to failure. Maximum load to failure, including tendon load and pinch force,
was recorded for each tendon. We propose that combining the advantages of cyclical
testing and a curvilinear model is the most effective way of testing flexor tendon
repairs capable of undergoing an early active motion protocol. None of the repaired
tendons failed during the cyclic portion of testing. The average gapping after cycling
for the 3 suture techniques was 0.12 ± 0.35 mm for the Kessler technique, 0.00 ± 0.00
mm for the Strickland technique, and 0.19 ± 0.26 mm for the modified Becker technique.
The maximum tendon loads to failure were 33.8 ± 6.8 N for the Kessler technique, 30.4
± 5.64 N for the Strickland technique, and 76.3 ± 9.02 N for the modified Becker technique.
There was a statistically significant difference between the modified Becker repair
and the other 2 repairs for maximum tendon load and pinch force to failure. The results
of this study show that all 3 tendon repair techniques can withstand forces reported
with passive motion, but only the modified Becker repair allows sufficient strength
above those forces that are estimated for active motion during tendon healing. (J
Hand Surg 2000;25A:1127-1134. Copyright © 2000 by the American Society for Surgery
of the Hand.)
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Hand SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Controlled passive motion following flexor tendon repair in zones 2 and 3.in: AAOS: symposium on tendon surgery in the hand. CV Mosby, St Louis1975: 105-114
- Early active motion in flexor tendon healing.J Bone Joint Surg. 1972; 54A (abstr): 911
- The excursion and deformation of repaired flexor tendons treated with protected early motion.J Hand Surg. 1986; 11A: 106-110
- The effects of mobilization on the vascularization of healing flexor tendons in dogs.Clin Orthop. 1980; 153: 283-289
- Effects of early intermittent passive mobilization on healing canine flexor tendons.J Hand Surg. 1982; 7: 170-175
- Primary repair of lacerated flexor tendon in “no man's land.”.J Bone Joint Surg. 1967; 49A (abstr): 577
- Flexor tendon repair in zone II with a new suture technique and an early mobilization program combining passive and active flexion.J Hand Surg. 1994; 19A: 53-60
- Digital function following flexor tendon repair in zone II: a comparison of immobilization and controlled passive motion techniques.J Hand Surg. 1980; 5: 537-543
- Early active motion following a beveled technique of flexor tendon repair: report on fifty cases.J Hand Surg. 1979; 4: 454-460
- Primary repair of flexor tendons in the hand without immobilization—preliminary report.Hand. 1978; 10: 37-47
- Flexor tendon repair in zone 2 followed by controlled active mobilisation.J Hand Surg. 1989; 14B: 392-395
- Concepts that changed flexor tendon surgery.in: Tendon and nerve surgery in the hand: a third decade. Mosby, St Louis1997: 307-313
- A comparison of post-operative mobilization of flexor tendon repairs with “passive flexion-active extension” and “controlled active motion” techniques.J Hand Surg. 1994; 19B: 517-521
- The rupture rate of acute flexor tendon repairs mobilized by the controlled active motion regimen.J Hand Surg. 1994; 19B: 607-612
- Biomechanical and histologic characteristics of canine flexor tendon repair using early postoperative mobilization.J Hand Surg. 1997; 22A: 107-114
- A comparative study of two methods of controlled mobilization of flexor tendon repairs in zone 2.J Hand Surg. 1998; 23B: 41-45
- Tendon suturing methods: analysis of tensile strength.in: American Academy of Orthopaedic Surgeons. Symposium on tendon surgery in the hand. CV Mosby, St Louis1975: 70-80
- Flexor tendon forces: in vivo measurements.J Hand Surg. 1992; 17A: 291-298
- In vitro studies of a new method of flexor tendon repair.J Hand Surg. 1985; 10B: 135-141
- Double loop locking suture: a technique of tendon repair for early active mobilization. Part II: clinical experience.J Hand Surg. 1990; 15A: 953-958
- Strength of the suture in the epitenon and within the tendon fibres: development of stronger peripheral suture technique.J Hand Surg. 1992; 17B: 171-175
- Effects of constant mechanical tension on the healing of rabbit flexor tendons.Clin Orthop. 1993; 296: 301-306
- Clinical mechanics of the hand.in: CV Mosby, St. Louis1985: 85-86
- Tensile strength of flexor tendon repairs in a dynamic cadaver model.J Hand Surg. 1996; 21A: 605-611
- Flexor tendon injuries: I. Foundations of treatment.J Am Acad Orthop Surg. 1995; 3: 44-54
- Dynamic analysis of profundus tendon function.J Hand Surg. 1994; 19A: 626-635
- Biomechanical analysis of four-strand extensor tendon repair techniques.J Hand Surg. 1997; 22A: 838-842
- Mechanical analysis of tendon suture techniques.J Hand Surg. 1994; 19A: 641-647
- Eliminating the gap in flexor tendon surgery: a new method of suture.Hand. 1977; 9: 306-311
- Suture materials and suture techniques used in tendon repair.Hand Clin. 1985; 1: 43-53
- Digital flexor tendons: an experimental study. Part I. The significance of each component of the flexor mechanism in tendon healing.B J Plast Surg. 1960; 12: 289-316
- Cyclic stress analysis of flexor tendon repair.J Hand Surg. 1991; 16A: 701-707
- Cyclic stress testing after in vivo healing of canine flexor tendon lacerations.J Hand Surg. 1996; 21A: 974-977
- A new type of flexor tendon repair: biomechanical evaluation by cyclic loading, ultimate strength and assessment of pulley friction in vitro.J Hand Surg. 1995; 20B: 578-583
- Primary repair without immobilization of flexor tendon division within the digital sheath: an experimental and clinical study.Act Orthop Scand. 1969; 40: 587-601
- Flexor tendon repair.Hand Clin. 1985; 1: 55-68
- Augmented Becker versus modified Kessler tenorrhaphy in monkeys: dynamic mechanical analysis.J Hand Surg. 1995; 20A: 267-272
Cohen MJ, Hamman J, Mass DP. Flexor tendon repair: mechanical properties of five circumferential suturing techniques. J Hand Surg (in press).
- A randomized biomechanical study of zone II flexor tendon repairs analyzed in an in vitro model.J Hand Surg. 1998; 23A: 1046-1051
Article info
Publication history
Accepted:
July 12,
2000
Received:
July 28,
1998
Footnotes
*Supported by a grant from the American Society for Surgery of the Hand.
**No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.
★Reprint requests: Daniel P. Mass, MD, 5841 S Maryland Ave MC 3079, Chicago, IL 60637.
Identification
Copyright
© 2000 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
