title: Flexor digitorum profundus tendon-to-bone repair: an ex vivo biomechanical analysis of 3 pullout suture techniques.
abstract: Avulsions or distal transsections of the flexor digitorum profundus tendon are typically repaired by direct suture of tendon to the distal phalanx. The tensile properties of tendon-tobone repairs performed in cadaver fingers using 3 common suture patterns, the Bunnell, the Kessler, and the Kleinert techniques, were compared; 3-0 Prolene (monofilament) suture was used. Repairs done using the Kessler pattern had an average yield force of 30 N, compared to 39 N for the Bunnell and Kleinert patterns. Although these average yield forces were greater than that required for active digital flexion, considerable elongation (average, 8 mm) was measured at a force of 20 N. Data indicated that the safety factor achieved with these repair methods is lower than that achieved with modern tendon-to-tendon repair methods. The authors conclude that the common tendon-to-bone repair techniques are insufficient to withstand the higher forces associated with controlled passive and active motion rehabilitation methods that are currently advocated.
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Silva
authors.forename: S B
authors.initials: SB
authors.lastname: Hollstien
authors.forename: M D
authors.initials: MD
authors.lastname: Brodt
authors.forename: M I
authors.initials: MI
authors.lastname: Boyer
authors.forename: A M
authors.initials: AM
authors.lastname: Tetro
authors.forename: R H
authors.initials: RH
authors.lastname: Gelberman
mesh_terms: D000368:Aged; D002102:Cadaver; D005384:Finger Joint / Q000502:physiology / Q000601:surgery; D005385:Fingers / Q000502:physiology / Q000601:surgery*; D006801:Humans; D011126:Polypropylenes; D011897:Random Allocation; D013536:Suture Techniques; D013537:Sutures; D013710:Tendons / Q000502:physiology / Q000601:surgery*; D013718:Tensile Strength
chemical_list: D011126:Polypropylenes