title: Comparison of Flexor Tendon Repair Between 6-Strand Lim-Tsai With 4-Strand Cruciate and Becker Technique.
abstract: OBJECTIVE
  To compare the strength of 6-strand Lim-Tsai repair with 4-strand cruciate and Becker repair, which were done using braided polyblend. We hypothesized that the biomechanical strength of 4-strand repair could be as strong as 6-strand repair because of different flexor tendon repair configurations and uneven load bearing.
  
  
  METHODS
  We harvested 60 porcine flexor tendons. A transverse cut at the middle of the tendons was made to perform tendon repair. Six-strand Lim-Tsai repair (consisting of 2 Lim-Tsai locking loops), 4-strand cruciate repair (with 3 cross-stitch loops), and 4-strand Becker repair (with 2 double cross-stitch locking loops) were used for the repairs. The repaired tendons were pulled until failure using a mechanical tester. We recorded ultimate tensile strength, load to 2-mm gap force, stiffness, and mechanism of failure.
  
  
  RESULTS
  The Becker repairs had significantly greater tensile strength than the cruciate and Lim-Tsai repairs. The load to 2-mm gap force and stiffness were significantly greater for cruciate repairs and Becker repairs than Lim-Tsai repairs.
  
  
  CONCLUSIONS
  The biomechanical strength of 4-strand and Becker repairs could be as strong as 6-strand Lim-Tsai repairs. This study implies that the number of strands crossing the repair site of tendons may not be proportional to the biomechanical strength of flexor tendon repair.
  
  
  CONCLUSIONS
  Hand surgeons are urged to be aware of the biomechanic characteristics of different flexor tendon repair techniques used in the clinical setting.
authors.affiliation: Biomechanics Laboratory, Singapore General Hospital, Singapore.
authors.forename: Yoke-Rung
authors.initials: YR
authors.lastname: Wong
authors.affiliation: Department of Hand Surgery, Singapore General Hospital, Singapore.
authors.forename: Chuan Shing
authors.initials: CS
authors.lastname: Lee
authors.affiliation: Biomechanics Laboratory, Singapore General Hospital, Singapore.
authors.forename: Austin M K
authors.initials: AM
authors.lastname: Loke
authors.affiliation: Department of Hand Surgery, Singapore General Hospital, Singapore.
authors.forename: Xuan
authors.initials: X
authors.lastname: Liu
authors.affiliation: Biomechanics Laboratory, Singapore General Hospital, Singapore.
authors.forename: Ita
authors.initials: I
authors.lastname: Suzana MJ
authors.affiliation: Biomechanics Laboratory, Singapore General Hospital, Singapore; Department of Hand Surgery, Singapore General Hospital, Singapore. Electronic address: tay.shian.chao@sgh.com.sg.
authors.forename: Shian Chao
authors.initials: SC
authors.lastname: Tay
mesh_terms: D000818:Animals; D001696:Biomechanical Phenomena; D005552:Forelimb; D008422:Materials Testing; D013536:Suture Techniques; D013537:Sutures; D013552:Swine; D013710:Tendons / Q000601:surgery*; D013718:Tensile Strength
keywords: Flexor tendon repair; multistrand; ultimate tensile strength; uneven load bearing