title: The strength of the 6-strand modified Kessler repair performed with triple-stranded or triple-stranded bound suture in a porcine extensor tendon model: an ex vivo study.
abstract: OBJECTIVE
  To investigate the biomechanic influence of triple-stranded sutures and the spatial arrangement of the strands on the strength of the 6-strand Pennington modified Kessler repair.
  
  
  METHODS
  In the present ex vivo study of pig extensor tendons 2 techniques were used: (1) triple-stranded suture (3 suture strands in the same needle) and (2) triple-stranded bound suture (3 suture strands in the same needle that were bound together, parallel to each other, side by side). The repairs were subjected to static tensile testing.
  
  
  RESULTS
  The 6-strand modified Kessler repair performed with triple-stranded bound suture reached significantly higher yield force, ultimate force, and both partial and total 1-, 2-, and 3-mm gap forces compared with the repairs performed with triple-stranded suture. The stiffness and strain values at the yield point and at the ultimate point did not differ significantly.
  
  
  CONCLUSIONS
  This experimental study introduces a way to improve the strength of the tendon repair. The triple-stranded bound suture significantly increased both the gap resistance and ultimate force of the 6-strand modified Kessler repair. We assume the improvements are due to increased holding capacity of the locking loops. The triple-stranded bound suture is easy to use and avoids several problems associated with traditional multistrand repairs. Further studies are needed before clinical use can be considered.
authors.affiliation: Department of Orthopaedics and Traumatology, Helsinki University Hospital, Helsinki, Finland. anna.viinikainen@hus.fi
authors.forename: Anna
authors.initials: A
authors.lastname: Viinikainen
authors.forename: Harry
authors.initials: H
authors.lastname: Göransson
authors.forename: Katja
authors.initials: K
authors.lastname: Huovinen
authors.forename: Minna
authors.initials: M
authors.lastname: Kellomäki
authors.forename: Pertti
authors.initials: P
authors.lastname: Törmälä
authors.forename: Pentti
authors.initials: P
authors.lastname: Rokkanen
mesh_terms: D000818:Animals; D001696:Biomechanical Phenomena; D016001:Confidence Intervals; D066298:In Vitro Techniques; D013536:Suture Techniques; D013552:Swine; D013710:Tendons / Q000601:surgery*; D013718:Tensile Strength