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Effects of a Q Suture Technique as a Core Suture on Resistance to Gap Formation and Tensile Strength in an Ex Vivo Porcine Flexor Tendon Model

  • Ya Fang Wu
    Correspondence
    Corresponding author: Ya Fang Wu, MD, Department of Hand Surgery, Affiliated Hospital of Nantong University, 20 Xisi Road, Nantong 226001, Jiangsu, China.
    Affiliations
    Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
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Published:September 27, 2022DOI:https://doi.org/10.1016/j.jhsa.2022.08.002

      Purpose

      The Q suture has been reported to be an effective alternative to conventional peripheral sutures in tendon repair. Whether the Q method can be used as a core suture rather than a peripheral suture by adjusting the purchase length is unknown. We tested a double Q suture technique with variable purchase length and studied its effects on gap formation and tensile strength using an ex vivo model.

      Methods

      Forty pig flexor tendons were repaired using the double Q sutures with purchase lengths of 2, 4, 6, and 8 mm. Twenty tendons repaired using the double Tsuge and double Kessler sutures with an 8-mm purchase length were used as controls. The tendons were subjected to cyclic loading and load-to-failure. The number of tendons that formed an initial or 2-mm gap between the tendon ends, gap distance at the repair site, stiffness, and ultimate strength were recorded.

      Results

      During cyclic loading, the double Q suture with a 4–8-mm purchase had fewer tendons form an initial or 2-mm gap and a smaller gap size at the repair site than the Tsuge and Kessler sutures. The stiffness of the double Q suture with a 6–8-mm purchase length and Tsuge suture was greater than those of the double Kessler suture. The double Q suture with a 2-mm purchase length had smaller ultimate strength than the other sutures.

      Conclusions

      The Q suture may be an effective tendon repair method whose role can be converted between peripheral and core sutures via adjusting the suture purchase length. With an optimal suture length of 4–6 mm, the double Q method had tensile resistance superior to 4-strand core sutures.

      Clinical relevance

      The double Q suture may be a viable option as a core suture in flexor tendon repair when the purchase length is appropriately adjusted.

      Key words

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      References

        • Savage R.
        The search for the ideal tendon repair in zone 2: strand number, anchor points and suture thickness.
        J Hand Surg Eur Vol. 2014; 39: 20-29
        • Pan Z.J.
        • Qin J.
        • Zhou X.
        • Chen J.
        Robust thumb flexor tendon repairs with a six-strand M-Tang method, pulley venting, and early active motion.
        J Hand Surg Eur Vol. 2017; 42: 909-914
        • Zhou X.
        • Li X.R.
        • Qing J.
        • Jia X.F.
        • Chen J.
        Outcomes of the six-strand M-Tang repair for zone 2 primary flexor tendon repair in 54 fingers.
        J Hand Surg Eur Vol. 2017; 42: 462-468
        • Cao Y.
        • Zhu B.
        • Xie R.G.
        • Tang J.B.
        Influence of core suture purchase length on strength of four-strand tendon repairs.
        J Hand Surg Am. 2006; 31: 107-112
        • Tang J.B.
        • Zhang Y.
        • Cao Y.
        • Xie R.G.
        Core suture purchase affects strength of tendon repairs.
        J Hand Surg Am. 2005; 30: 1262-1266
        • Lee S.K.
        • Goldstein R.Y.
        • Zingman A.
        • Terranova C.
        • Nasser P.
        • Hausman M.R.
        The effects of core suture purchase on the biomechanical characteristics of a multistrand locking flexor tendon repair: a cadaveric study.
        J Hand Surg Am. 2010; 35: 1165-1171
        • Wu Y.F.
        • Tang J.B.
        Effects of tension across the tendon repair site on tendon gap and ultimate strength.
        J Hand Surg Am. 2012; 37: 906-912
        • Kanchanathepsak T.
        • Wairojanakul W.
        • Suppaphol S.
        • Watcharananan I.
        • Tuntiyatorn P.
        • Tawonsawatruk T.
        Evaluation of biomechanical properties on partial and complete epitendinous suture in human cadaver flexor tendon repair.
        J Orthop Surg Res. 2021; 16: 489
        • Duffy D.J.
        • Chang Y.J.
        • Gaffney L.S.
        • Fisher M.B.
        • Moore G.E.
        Effect of bite depth of an epitendinous suture on the biomechanical strength of repaired canine flexor tendons.
        Am J Vet Res. 2019; 80: 1043-1049
        • Walbeehm ET, De Wit T.
        • Hovius S.E.
        • McGrouther D.A.
        Influence of core suture geometry on tendon deformation and gap formation in porcine flexor tendons.
        J Hand Surg Eur Vol. 2009; 34: 190-195
        • Peltz T.S.
        • Haddad R.
        • Walsh W.R.
        The change in three-dimensional geometry of the Kessler flexor tendon repair under tension: a qualitative assessment using radiographs.
        J Hand Surg Eur Vol. 2010; 35: 676-677
        • Wu Y.F.
        • Mao W.F.
        • Tang J.B.
        The impact of transverse components on 4-strand tendon repairs.
        J Hand Surg Eur Vol. 2021; 46: 830-835
        • Wu Y.F.
        • Tang J.B.
        The impact of transverse components on resistance and ultimate strength of 6-strand tendon repairs.
        J Hand Surg Eur Vol. 2021; 46: 836-841
        • Chen J.
        • Wang K.
        • Katirai F.
        • Chen Z.
        A new modified Tsuge suture for flexor tendon repairs: the biomechanical analysis and clinical application.
        J Orthop Surg Res. 2014; 9: 136
        • Dündar N.
        • Güneri B.
        • Uzel M.
        • Doğaner A.
        Biomechanical comparison of Bunnell, modified Kessler, and Tsuge tendon repair techniques using two suture types.
        Acta Orthop Traumatol Turc. 2020; 54: 104-113
        • Al-Qattan M.M.
        • Mirdad A.T.
        • Hafiz M.O.
        Suture purchase length: a biomechanical study of flexor tendon repair in newborn lambs.
        J Hand Surg Am. 2013; 38: 62-65
        • Al-Thunayan T.A.
        • Al-Zahrani M.T.
        • Hakeem A.A.
        • Al-Zahrani F.M.
        • Al-Qattan M.M.
        A biomechanical study of pediatric flexor profundus tendon repair. Comparing the tensile strengths of 3 suture techniques.
        Saudi Med J. 2016; 37: 957-962
        • Mao W.F.
        • Wu Y.F.
        Effects of a Q suture technique on resistance to gap formation and tensile strength of repaired tendons: an ex vivo mechanical study.
        J Hand Surg Am. 2020; 45: 258.e1-258.e7
        • Mao W.F.
        • Wu Y.F.
        Using Q suture to enhance resistance to gap formation and tensile strength of repaired flexor tendons.
        J Vis Exp. 2020; 160https://doi.org/10.3791/61445
        • Mao W.F.
        • Wu Y.F.
        • Zhou Y.L.
        • Tang J.B.
        A study of the anatomy and repair strengths of porcine flexor and extensor tendons: are they appropriate experimental models?.
        J Hand Surg Eur Vol. 2011; 36: 663-669
        • Tang J.B.
        Re: Levels of experience of surgeons in clinical studies.
        J Hand Surg Eur. 2009; 34: 137-138
        • Wit T.
        • Walbeehm E.T.
        • Hovius S.E.
        • McGrouther D.A.
        The mechanical interaction between three geometric types of nylon core suture and a running epitenon suture in repair of porcine flexor tendons.
        J Hand Surg Eur. 2013; 38: 788-794
        • Kim J.B.
        • de Wit T.
        • Hovius S.E.
        • McGrouther D.A.
        • Walbeehm E.T.
        What is the significance of tendon suture purchase?.
        J Hand Surg Eur. 2009; 34: 497-502