title: Biomechanical analysis of flexor tendon repair using knotted Kessler and Bunnell techniques and the knotless Bunnell technique.
abstract: OBJECTIVE
  To evaluate a knotless Bunnell suture in flexor tendon repair.
  
  
  METHODS
  Eighty porcine flexor digitorum tendons were assigned to 4 different suture techniques. Group 1 was repaired using a modified 4-strand knotted Kessler suture and served as a control group. Group 2 was repaired using a 4-strand knotted Bunnell suture. Group 3 used a 4-strand knotless Bunnell suture. Group 4 used a 4-strand knotless Bunnell and knotless peripheral suture. Under static and cyclic testing we studied mode of failure, 2-mm gap formation force, displacement, and maximum load.
  
  
  RESULTS
  The 4-strand knotless Bunnell suture did not show a notable difference with regard to 2-mm gap formation force, displacement, or maximum load in comparison to the modified 4-strand knotted Kessler suture. Adding a knotless peripheral suture improved the repair by a significant reduction of gap formation and displacement and an increase in maximum load. The 4-strand knotted Bunnell showed the highest maximum load but also a considerable lower resistance to gap formation and major displacement.
  
  
  CONCLUSIONS
  Flexor tendon repair using a 4-strand knotless Bunnell suture showed similar tensile strength to a modified 4-strand knotted Kessler suture. Adding a knotless peripheral suture further improved the repair.
  
  
  CONCLUSIONS
  A complete knotless 4-strand Bunnell suture including a barbed core- and peripheral suture might be an option for flexor tendon reconstruction.
authors.affiliation: Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital, Würzburg, Germany.
authors.forename: Martin C
authors.initials: MC
authors.lastname: Jordan
authors.affiliation: Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital, Würzburg, Germany.
authors.forename: Karsten
authors.initials: K
authors.lastname: Schmidt
authors.affiliation: Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital, Würzburg, Germany.
authors.forename: Rainer H
authors.initials: RH
authors.lastname: Meffert
authors.affiliation: Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital, Würzburg, Germany. Electronic address: Hoelscher_S@ukw.de.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Hoelscher-Doht
mesh_terms: D000818:Animals; D001696:Biomechanical Phenomena; D023421:Models, Animal; D013536:Suture Techniques; D013552:Swine; D013708:Tendon Injuries / Q000601:surgery*; D013710:Tendons / Q000601:surgery; D013718:Tensile Strength
keywords: 4-strand Bunnell; Barbed suture; Bunnell suture; double Bunnell; flexor tendon repair