title: A Mechanical Evaluation of Zone II Flexor Tendon Repair Using a Knotless Barbed Suture Versus a Traditional Braided Suture.
abstract: OBJECTIVE
  To determine repair site bulk, gliding resistance, work of flexion, and 1-mm gap formation force in zone II flexor tendon lacerations repaired with knotless barbed or traditional braided suture.
  
  
  METHODS
  Transverse zone II lacerations of the flexor digitorum profundus (FDP) tendon were created in 36 digits from 6 matched human cadaveric pairs. Repair was performed with 2-0 barbed suture (n = 18) or 3-0 polyethylene braided suture (n = 18). Pre- and postrepair cross-sectional area was measured followed by quantification of gliding resistance and work of flexion during cyclic flexion-extension loading at 10 mm/min. Thereafter, the repaired tendons were loaded to failure. The force at 1 mm of gap formation was recorded.
  
  
  RESULTS
  Repaired FDP tendon cross-sectional area increased significantly from intact, with no difference noted between suture types. Gliding resistance and work of flexion were significantly higher for both suture repairs; however, we identified no significant differences in either nondestructive biomechanical parameters between repair types. Average 1-mm gap formation force with the knotless barbed suture (52 N) was greater than that of the traditional braided suture (43 N).
  
  
  CONCLUSIONS
  We identified no significant advantage in using knotless barbed suture for zone II FDP repair in our primary, nondestructive mechanical outcomes in this in vitro study.
  
  
  CONCLUSIONS
  In vivo studies may be warranted to determine if one suture method has an advantage with respect to the parameters tested at 4, 6, and 12 plus weeks postrepair and the degree of adhesion formation. The combined laboratory and clinical data, in additional to cost considerations, may better define the role of barbed knotless suture for zone II flexor tendon repair.
authors.affiliation: Foundation for Orthopaedic Research & Education, Tampa, FL.
authors.forename: Aniruddh N
authors.initials: AN
authors.lastname: Nayak
authors.affiliation: Florida Orthopaedic Institute, Tampa, FL.
authors.forename: Dzi-Viet
authors.initials: DV
authors.lastname: Nguyen
authors.affiliation: Florida Orthopaedic Institute, Tampa, FL.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Brabender
authors.affiliation: Department of Surgery, Emory School of Medicine, Atlanta, GA.
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Hiro
authors.affiliation: Department of Orthopaedics & Sports Medicine, University of South Florida, Tampa, FL.
authors.forename: Jeremy J
authors.initials: JJ
authors.lastname: Miles
authors.affiliation: Department of Orthopaedics & Sports Medicine, University of South Florida, Tampa, FL.
authors.forename: Ian R
authors.initials: IR
authors.lastname: Smithson
authors.affiliation: Foundation for Orthopaedic Research & Education, Tampa, FL. Electronic address: bsantoni@foreonline.org.
authors.forename: Brandon G
authors.initials: BG
authors.lastname: Santoni
authors.affiliation: Florida Orthopaedic Institute, Tampa, FL.
authors.forename: Jeffery D
authors.initials: JD
authors.lastname: Stone
authors.affiliation: Florida Orthopaedic Institute, Tampa, FL.
authors.forename: Alfred V
authors.initials: AV
authors.lastname: Hess
mesh_terms: D000368:Aged; D001696:Biomechanical Phenomena; D002102:Cadaver; D005260:Female; D005385:Fingers / Q000601:surgery*; D006801:Humans; D066298:In Vitro Techniques; D008297:Male; D013536:Suture Techniques; D013537:Sutures; D013708:Tendon Injuries / Q000601:surgery*
keywords: FDP repair strength; Zone II flexor tendon laceration; flexor tendon repair; gliding resistance; knotless barbed sutures