title: Tensile strength of a new suture for fixation of tendon grafts when using a weave technique.
abstract: OBJECTIVE
  To evaluate a new corner stitch construct for tendon graft or tendon transfer fixation and compare the tensile strength with a conventional central cross-suture design in human cadaver tendons.
  
  
  METHODS
  Flexor digitorum profundus tendons of the index, middle, and ring fingers (48 total) were used as recipients and palmaris longus, extensor indicis proprius, and extensor digitorum communis tendons of the index finger (48 total) were used as grafts from 16 fresh-frozen human cadaver hands. We compared the cross-stitch technique with a new corner stitch technique in tendon repairs made with 1, 2, or 3 weaves (8 per group). Tendons were sutured at each weave with either 2 full-thickness cross-stitches or 4 partial-thickness corner stitches of 4-0 nylon. Mattress sutures also were placed through the free tendon end for each repair type. The tensile strength of the tendon-graft composite was measured with a materials testing machine.
  
  
  RESULTS
  The tensile strength of the repairs increased significantly with the number of weaves. When 2 or 3 weaves were used with the corner stitch or when 3 weaves were used with the cross-stitch, the repairs were significantly stronger. Although no significant difference in strength to failure was noted when comparing cross and corner stitches with equivalent numbers of weaves, qualitatively there was a difference in mode of failure with the 3-weave corner stitches failing primarily by intrasubstance tendon failure and the 3-weave cross-stitch repairs failing by tendon pullout.
  
  
  CONCLUSIONS
  The corner stitch is as strong as conventional cross-stitch repairs and its superficial placement may be more favorable to tendon blood supply. This repair may be advantageous for clinical applications.
authors.affiliation: Biomechanics Laboratory, Division of Orthopaedic Research, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Tanaka
authors.forename: Chunfeng
authors.initials: C
authors.lastname: Zhao
authors.forename: Anke M
authors.initials: AM
authors.lastname: Ettema
authors.forename: Mark E
authors.initials: ME
authors.lastname: Zobitz
authors.forename: Kai-Nan
authors.initials: KN
authors.lastname: An
authors.forename: Peter C
authors.initials: PC
authors.lastname: Amadio
mesh_terms: D005385:Fingers / Q000601:surgery*; D006801:Humans; D066298:In Vitro Techniques; D009757:Nylons; D012307:Risk Factors; D013529:Surgical Wound Dehiscence / Q000503:physiopathology*; D013536:Suture Techniques; D013537:Sutures; D013709:Tendon Transfer / Q000379:methods*; D013710:Tendons / Q000503:physiopathology*; D013718:Tensile Strength
chemical_list: D009757:Nylons