title: Comparison of an all-inside suture technique with traditional pull-out suture and suture anchor repair techniques for flexor digitorum profundus attachment to bone.
abstract: OBJECTIVE
  One goal in repairing zone 1 flexor digitorum profundus (FDP) injuries is to create a tendon-bone construct strong enough to allow early rehabilitation while minimizing morbidity. This study compares an all-inside suture repair technique biomechanically with pull-out suture and double-suture anchor repairs.
  
  
  METHODS
  Repairs were performed on 30 cadaver fingers. In all-inside suture repairs (n = 8), the FDP tendon was attached to bone with two 3-0 Ethibond sutures and tied over the dorsal aspect of distal phalanx. Pull-out suture repairs (n = 8) were performed with 2-0 Prolene suture and tied over a dorsal button. There were 2 suture anchor repair groups: Arthrex Micro Corkscrew anchors preloaded with 2-0 FiberWire suture (n = 7) and Depuy Micro Mitek anchors preloaded with 3-0 Orthocord suture (n = 7). Repair constructs were tested using a servohydraulic materials testing system and loaded until the repair lost 75% of its strength.
  
  
  RESULTS
  There were no statistically significant differences in tensile stiffness, ultimate load, or work to failure between the repairs. Failure mode was suture stretch and gap formation greater than 2 mm at the repair site for all pull-out suture repairs and for 7 of 8 all-inside suture repairs. Two of the Arthrex Micro Corkscrew repairs and 5 of the Depuy Micro Mitek repairs failed by anchor pull-out.
  
  
  CONCLUSIONS
  This cadaveric biomechanical study showed no difference in tensile stiffness, ultimate load, and work to failures between an all-inside suture repair technique for zone 1 FDP repairs and previously described pull-out suture and suture anchor repair techniques. The all-inside suture technique also has the advantages of avoiding an external button and the cost of anchors. Therefore, it should be considered as an alternative to other techniques.
  
  
  CONCLUSIONS
  This study introduces a new FDP reattachment technique that avoids some of the shortcomings of current techniques.
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation, Center for Musculoskeletal Research, and Department of Biomedical Engineering, University of Rochester Medical Center, Rochester, New York 14642, USA.
authors.forename: Jennifer Y
authors.initials: JY
authors.lastname: Chu
authors.forename: Tony
authors.initials: T
authors.lastname: Chen
authors.forename: Hani A
authors.initials: HA
authors.lastname: Awad
authors.forename: John
authors.initials: J
authors.lastname: Elfar
authors.forename: Warren C
authors.initials: WC
authors.lastname: Hammert
mesh_terms: D001696:Biomechanical Phenomena; D005383:Finger Injuries / Q000601:surgery*; D006801:Humans; D011093:Polyethylene Terephthalates; D053441:Suture Anchors; D013536:Suture Techniques; D013537:Sutures; D013708:Tendon Injuries / Q000601:surgery*; D013718:Tensile Strength
chemical_list: C014534:Ethibond; D011093:Polyethylene Terephthalates