title: The effect of the number of cross-stitches on the biomechanical properties of the modified becker extensor tendon repair.
abstract: OBJECTIVE
  The optimum number of cross-stitches in modified Becker repair for extensor tendon injury is not known. The purpose of this study was to compare the biomechanical characteristics of 1, 2, and 3 cross-stitches in modified Becker extensor repairs.
  
  
  METHODS
  We used 8 fresh-frozen cadaveric hands (24 fingers). We exposed extensor tendons of the index, middle, and ring fingers over the proximal phalanx, cut them transversely at the mid-portion of zone IV (proximal phalanx), and repaired them in situ with a modified Becker technique with 1, 2, or 3 cross-stitches using 4-0 braided suture. We randomized the tendons within each hand for the number of cross-stitches. Stiffness, yield load, ultimate load, energy absorbed, and gap formation were measured. After a 5 N preload, each repair was cyclically loaded from 5 to 25 N for 30 cycles and from 5 to 35 N for 30 cycles at a rate of 20 mm/min to simulate loads during postoperative rehabilitation. After cyclic loading, the specimens were loaded to failure.
  
  
  RESULTS
  The repair with 1 cross-stitch showed superior gap resistance and stiffness during cyclic loading compared with 2 and 3 cross-stitches. One cross-stitch also resulted in higher stiffness and yield strength in load to failure testing. However, 3 cross-stitch configurations displayed higher ultimate strength. All repairs failed by knot slippage.
  
  
  CONCLUSIONS
  A modified Becker extensor tendon repair with 1 cross-stitch provides superior mechanical properties for loads seen with postoperative rehabilitation compared with 2 and 3 cross-stitches for similar loads.
  
  
  CONCLUSIONS
  These findings may lead to reduced operative time and decreased tendon damage with superior results.
authors: Orthopaedic Biomechanics Laboratory, VA Long Beach Healthcare System and University of California, Irvine, Long Beach, CA, USA.
authors: Kyung-Chil
authors: KC
authors: Chung
authors: Bong Jae
authors: BJ
authors: Jun
authors: Michelle H
authors: MH
authors: McGarry
authors: Thay Q
authors: TQ
authors: Lee
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D005383:Finger Injuries / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D016059:Range of Motion, Articular; D013536:Suture Techniques; D013708:Tendon Injuries / Q000601:surgery*; D013718:Tensile Strength; D016474:Weight-Bearing