Extensor tendon injuries are common; however, relatively few studies have evaluated extensor tendon repair methods. The purpose of this study was to investigate the properties of the running-interlocking horizontal mattress repair method with regard to tendon shortening, stiffness, strength, and time needed to perform the repair, compared with the modified Bunnell method and the augmented Becker method.
Twenty-four extensor tendons from 8 fresh-frozen cadaveric hands were harvested from zone 6. The harvested tendons were randomly assigned into 1 of 3 repair groups: augmented Becker, modified Bunnell, and running-interlocking horizontal mattress repair methods. The running-interlocking horizontal mattress repair combines a running suture with an interlocking horizontal mattress suture. Each repaired tendon was measured for length before and after repair and tested for stiffness, ultimate load to failure, and time required to perform the repair.
The running-interlocking horizontal mattress repair was significantly stiffer (8,506 N/m) than the augmented Becker (5,971 N/m) and the modified Bunnell (6,719 N/m) repairs. The running-interlocking horizontal mattress repair resulted in significantly less shortening (1.7 mm) than the augmented Becker (6.2 mm) and modified Bunnell (6.3 mm) repairs. The running-interlocking horizontal mattress repair took significantly less time to perform without a significant difference in the ultimate load to failure (running-interlocking horizontal mattress repair, 51 N; augmented Becker, 53 N; modified Bunnell, 48 N).
The running-interlocking horizontal mattress repair is significantly stiffer and faster to perform than either the augmented Becker or the modified Bunnell repairs, and it results in less shortening than either of these methods. The running-interlocking horizontal mattress repair should be strong enough to withstand some early motion.
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 access
One-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 Surgery
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Early dynamic splinting for extensor tendon injuries.J Hand Surg. 1989; 14A: 72-76
- Early active short arc motion for the repaired central slip.J Hand Surg. 1994; 19A: 991-997
- Immediate active short arc motion following extensor tendon repair.Hand Clin. 1995; 11: 483-512
- Immediate controlled active motion following zone 4-7 extensor tendon repair.J Hand Ther. 2005; 18: 182-190
- Results of primary extensor tendon repair in relation to the zone of injury and pre-operative outcome estimation.Arch Orthop Trauma Surg. 2007; 127: 115-119
- Electrophysiologic basis of dynamic extensor splinting.J Hand Surg. 1992; 17A: 272-277
- Advances in extensor tendon diagnosis and therapy.Plast Reconstr Surg. 2009; 123: 52e-57e
- Biomechanical characteristics of extensor tendon suture techniques.J Hand Surg. 1992; 17A: 1117-1123
- Biomechanical analysis of four-strand extensor tendon repair techniques.J Hand Surg. 1997; 22A: 838-842
- Biomechanical properties of four circumferential flexor tendon suture techniques.J Hand Surg. 2003; 28A: 824-831
- Augmented Becker versus modified Kessler tenorrhaphy in monkeys: dynamic mechanical analysis.J Hand Surg. 1995; 20A: 267-272
- A biomechanical comparison of four extensor tendon repair techniques in zone IV.Plast Reconstr Surg. 2005; 115 (discussion 1682–1683): 1674-1681
- Long-term results of extensor tendon repair.J Hand Surg. 1990; 15A: 961-966
- Biomechanical characteristics of suture techniques in extensor zone IV.J Hand Surg. 1995; 20A: 650-656
- A clinical study of forces generated by the intrinsic muscles of the index finger and the extrinsic flexor and extensor muscles of the hand.J Hand Surg. 1978; 3: 571-578
Accepted: September 11, 2009
Received: April 6, 2009
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
© 2010 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.