title: A systematic review of 2-strand versus multistrand core suture techniques and functional outcome after digital flexor tendon repair.
abstract: OBJECTIVE
  To determine published evidence to evaluate the hypothesis that multistrand techniques result in a poorer outcome than 2-strand techniques for digital flexor tendon repairs.
  
  
  METHODS
  A systematic review was undertaken to compare outcomes and rupture rates between 2-strand and multistrand core sutures in digital flexor zones 2 to 5. Outcome was measured by the American Society for Surgery of the Hand criteria, original or modified Strickland criteria, or Buck-Gramcko criteria.
  
  
  RESULTS
  A total of 1,878 patients (2,585 digits; 3,749 tendons) were included from the selected studies. Thirty-three studies reported 2-strand repairs and 15 reported multistrand repairs. Of the total tendon injuries, 59% were flexor digitorum profundus, 38% were flexor digitorum superficialis, and 2% were flexor pollicis longus. The pooled rupture rate was 3.9 per 100 digits. No significant difference was detected between 2-strand and multistrand repairs for outcomes by all measures or rupture rate.
  
  
  CONCLUSIONS
  Because of the wide variation in reporting of outcomes and study design on which this analysis was based, we cannot definitively confirm our hypothesis. We present the standards for outcomes as well as rupture rate for digital flexor tendon repair.
  
  
  METHODS
  Therapeutic III.
authors.affiliation: Birmingham Hand Centre, University Hospitals of Birmingham NHS Foundation Trust, New Queen Elizabeth Hospital, Birmingham, United Kingdom; University of Birmingham, Edgbaston, Birmingham, United Kingdom. Electronic address: j.hardwicke@bham.ac.uk.
authors.forename: Joseph T
authors.initials: JT
authors.lastname: Hardwicke
authors.affiliation: Birmingham Hand Centre, University Hospitals of Birmingham NHS Foundation Trust, New Queen Elizabeth Hospital, Birmingham, United Kingdom; University of Birmingham, Edgbaston, Birmingham, United Kingdom.
authors.forename: Jessica J
authors.initials: JJ
authors.lastname: Tan
authors.affiliation: Birmingham Hand Centre, University Hospitals of Birmingham NHS Foundation Trust, New Queen Elizabeth Hospital, Birmingham, United Kingdom; University of Birmingham, Edgbaston, Birmingham, United Kingdom.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Foster
authors.affiliation: Birmingham Hand Centre, University Hospitals of Birmingham NHS Foundation Trust, New Queen Elizabeth Hospital, Birmingham, United Kingdom; University of Birmingham, Edgbaston, Birmingham, United Kingdom.
authors.forename: O Garth
authors.initials: OG
authors.lastname: Titley
mesh_terms: D006801:Humans; D019637:Orthopedic Procedures / Q000379:methods*; D020127:Recovery of Function; D012421:Rupture; D013536:Suture Techniques; D013708:Tendon Injuries / Q000601:surgery*; D016896:Treatment Outcome
keywords: Core suture; flexor tendon; outcomes; repair technique; systematic review