title: Biomechanical comparisons of four-strand tendon repairs with double-stranded sutures: effects of different locks and suture geometry.
abstract: Multi-strand repairs are often used in flexor tendon surgery. We evaluated the strength of four four-strand tendon repairs with different locks and suture geometry. Forty-eight pig flexor tendons were repaired with the following methods: a cross-lock four-strand repair; a U-shaped repair with circle-locks; a modified Kessler repair with Pennington locks (with longitudinal sutures located more centrally; and another modified Kessler (with longitudinal sutures located more laterally). The tendons were loaded to complete failure of the repairs. The two Kessler repairs showed a 35% lower 2 mm gap force, and 15% lower ultimate strength compared with the other two repairs; the differences were of statistical significance. The failure pattern was breakage of sutures in almost all tendons. These four-strand repairs differed in gapping and ultimate strengths. The Kessler-type repairs with different geometry in the longitudinal sutures produced identical strengths. The Kessler-type repairs with Pennington locks were weaker than the two repairs with either cross-locks or circle-locks.
authors.affiliation: Department of Hand Surgery, Hand Surgery Research Center, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China.
authors.forename: Y F
authors.initials: YF
authors.lastname: Wu
authors.forename: Y
authors.initials: Y
authors.lastname: Cao
authors.forename: Y L
authors.initials: YL
authors.lastname: Zhou
authors.forename: J B
authors.initials: JB
authors.lastname: Tang
mesh_terms: D000818:Animals; D001696:Biomechanical Phenomena; D013536:Suture Techniques; D013552:Swine; D013708:Tendon Injuries / Q000503:physiopathology / Q000601:surgery*; D013718:Tensile Strength / Q000502:physiology