Purpose
To compare the tensile properties of a 3-0, 4-strand flexor tendon repair with a 4-0,
4-strand repair and a 4-0, 8-strand repair.
Methods
Following evaluation of the intrinsic material properties of the 2 core suture calibers
most commonly used in tendon repair (3-0 and 4-0), we tested the mechanical properties
of 40 cadaver flexor digitorum profundus tendons after zone II repair with 1 of 3
techniques: a 3-0, 4-strand core repair, a 4-0, 8-strand repair, or a 4-0, 4-strand
repair. We compared results across suture caliber for the 2 sutures and across tendon
repair methods.
Results
Maximum load to failure of 3-0 polyfilament caprolactam suture was 49% greater than
that of 4-0 polyfilament caprolactam suture. The cross-sectional area of 3-0 polyfilament
caprolactam was 42% greater than that of 4-0 polyfilament caprolactam. The 4-0, 8-strand
repair produced greater maximum load to failure when compared with the 2 4-strand
techniques. Load at 2-mm gap, stiffness, and work to yield were significantly greater
in the 4-0, 8-strand repair than in the 3-0, 4-strand repair.
Conclusions
In an ex vivo model, an 8-strand repair using 4-0 suture was 43% stronger than a 4-strand repair
using 3-0 suture, despite the finding that 3-0 polyfilament caprolactam was 49% stronger
than 4-0 polyfilament caprolactam. These results suggest that, although larger-caliber
suture has superior tensile properties, the number of core suture strands across a
repair site has an important effect on time zero, ex vivo flexor tendon repair strength.
Clinical relevance
Surgeons should consider using techniques that prioritize multistrand core suture
repair over an increase in suture caliber.
Key words
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Article info
Publication history
Published online: December 16, 2013
Accepted:
November 6,
2013
Received:
July 24,
2013
Footnotes
This publication was supported by grants from the National Institutes of Health (AR062947, R.H.G. and S.T.) and the Washington University Institute of Clinical and Translational Sciences (UL1 TR000448, D.A.O.), from the National Center for Advancing Translational Sciences. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
