Comparative biomechanic performances of locked cruciate four-strand flexor tendon repairs in an ex vivo porcine model.
OBJECTIVE
To investigate the effects of 3 different locking configurations on repair strength when used in a cruciate four-strand repair.


METHODS
Sixty fresh porcine flexor tendons were transected and repaired with cruciate four-strand core suture repairs with 3 different locking configurations: simple locks (a modification of the Pennigton method), circle locks, and cross locks. Half of the repairs in each locking group were reinforced with a peripheral suture. The tendon repairs were subjected to linear load-to-failure testing. Outcome measures were 2-mm gap force and ultimate tensile strength.


RESULTS
The cross lock repair had significantly greater 2-mm gap force and ultimate tensile strength than the simple lock repair, both with and without a peripheral suture. The cross lock repair showed significantly greater 2-mm gap force without a peripheral suture and significantly greater ultimate tensile strength with a peripheral suture than the circle lock repair. With peripheral reinforcement, the cross lock cruciate repair had a mean 2-mm gap force of 92 N and ultimate tensile strength of 119 N. The cross lock cruciate repair consistently produced the strongest biomechanic performance in all outcome measures.


CONCLUSIONS
Locking configuration influences the biomechanic performance of cruciate four-strand flexor tendon repairs. Our results suggest that the cruciate repair with cross locks is stronger than repairs with simple locks or circle locks. Whether the results of this ex vivo porcine linear model can be translated to the clinical arena is unknown, because the factors of tendon/sheath friction, tendon healing, and compromised tendon viability from the lock were not addressed.
Croog
Alexander
A
Department of Orthopaedic Surgery, New York University-Hospital for Joint Diseases, New York, NY 10003, USA.
Goldstein
Rachel
R
Nasser
Philip
P
Lee
Steve K
SK
D000818:Animals; D023421:Models, Animal; D013536:Suture Techniques; D013552:Swine; D013708:Tendon Injuries / Q000601:surgery*; D013718:Tensile Strength