title: Flexor tendon repair using a new suture technique: a comparative in vitro biomechanical study.
abstract: BACKGROUND
  The purpose of this experimental study was to evaluate the biomechanical characteristics of two new four-strand core suture techniques for flexor tendon repair.
  
  
  METHODS
  The two new suture techniques (Marburg 1, Marburg 2) are characterized by four longitudinal stitches which are anchored by a circular or semicircular suture. They were compared with three commonly used core suture techniques (modified Kessler, Tsuge, Bunnell). Fifty porcine flexor tendons were randomly assigned to one of the five core suture techniques. Outcome measures included ultimate tensile strength, maximum of lengthening, mode of failure and 1 mm gap formation force.
  
  
  RESULTS
  The highest ultimate tensile strength was found for the modified Kessler technique (115 N). Both new techniques showed an ultimate load exceeding 50 N (57 N for Marburg 1, 54 N for Marburg 2). The Marburg 1 technique showed the highest gap resistance of all tested suture techniques. The Bunnell and Tsuge core suture techniques produced the poorest mechanical performance.
  
  
  CONCLUSIONS
  From these experimental results, the new Marburg 1 core suture technique can be considered for flexor tendon repair in a clinical setting with the use of active motion protocols.
authors.affiliation: Department of Trauma and Hand Surgery, University Hospital, Moorenstraße 5, 40225, Düsseldorf, Germany. schaedel@uni-duesseldorf.de.
authors.forename: M
authors.initials: M
authors.lastname: Schädel-Höpfner
authors.affiliation: Department of Trauma and Hand Surgery, University Hospital, Moorenstraße 5, 40225, Düsseldorf, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Windolf
authors.affiliation: Department of Trauma and Hand Surgery, University Hospital, Moorenstraße 5, 40225, Düsseldorf, Germany.
authors.forename: T T
authors.initials: TT
authors.lastname: Lögters
authors.affiliation: Department of Trauma and Hand Surgery, University Hospital, Moorenstraße 5, 40225, Düsseldorf, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Hakimi
authors.affiliation: Institute of Theoretical Surgery, University Hospital, Marburg, Germany.
authors.forename: I
authors.initials: I
authors.lastname: Celik
keywords: Biomechanical testing; Flexor tendon repair; Gap resistance; Marburg core suture technique; Ultimate tensile strength
references.citation: J Hand Surg Br. 1989 Nov;14(4):392-5
references.pmid: 2621397
references.citation: J Hand Surg Am. 1994 Sep;19(5):777-81
references.pmid: 7806799
references.citation: Can J Surg. 1995 Dec;38(6):528-32
references.pmid: 7497368
references.citation: J Hand Surg Br. 2005 Jun;30(3):307-9
references.pmid: 15862374
references.citation: J Hand Surg Am. 1997 Jan;22(1):107-14
references.pmid: 9018622
references.citation: J Orthop Res. 1993 Jul;11(4):603-11
references.pmid: 8340832
references.citation: Ann Chir Main Memb Super. 1997;16(3):229-34
references.pmid: 9421604
references.citation: J Hand Surg Am. 2002 May;27(3):508-17
references.pmid: 12015728
references.citation: J Hand Surg Am. 2005 Jul;30(4):836-41
references.pmid: 16039381
references.citation: J Hand Surg Am. 2000 Mar;25(2):214-35
references.pmid: 10722813
references.citation: Clin Orthop Relat Res. 1993 Nov;(296):301-6
references.pmid: 8222442
references.citation: J Hand Surg Br. 1995 Jun;20(3):310-3
references.pmid: 7561403
references.citation: J Hand Surg Am. 1992 Mar;17(2):291-8
references.pmid: 1564277
references.citation: J Hand Surg Br. 1992 Feb;17(1):92-3
references.pmid: 1640153
references.citation: J Hand Surg Am. 2000 May;25(3):499-506
references.pmid: 10811755
references.citation: J Hand Surg Am. 1995 Sep;20(5):801-7
references.pmid: 8522748
references.citation: J Hand Surg Br. 1989 May;14(2):232-5
references.pmid: 2664057
references.citation: Osteoarthritis Cartilage. 1999 Jan;7(1):141-53
references.pmid: 10367022
references.citation: J Hand Surg Am. 1999 Nov;24(6):1315-22
references.pmid: 10584960
references.citation: J Hand Surg Br. 2005 Aug;30(4):374-8
references.pmid: 15932784
references.citation: J Hand Surg Am. 1996 Jul;21(4):605-11
references.pmid: 8842951
references.citation: Orthop Rev. 1986 Nov;15(11):701-21
references.pmid: 3331175
references.citation: J Hand Surg Am. 1993 Jan;18(1):58-65
references.pmid: 8423320
references.citation: J Hand Surg Br. 1992 Feb;17(1):89-91
references.pmid: 1640152
references.citation: J Hand Surg Am. 2000 Nov;25(6):1127-34
references.pmid: 11119674
references.citation: Acta Orthop Scand. 2001 Dec;72(6):635-41
references.pmid: 11817881
references.citation: Clin Orthop Relat Res. 1995 Nov;(320):205-10
references.pmid: 7586828
references.citation: J Orthop Res. 1998 Jul;16(4):399-405
references.pmid: 9747779
references.citation: J Hand Surg Br. 1985 Jun;10(2):135-41
references.pmid: 3161963
references.citation: J Hand Surg Br. 1991 Feb;16(1):35-9
references.pmid: 2007811
references.citation: J Hand Surg Br. 2003 Aug;28(4):357-62
references.pmid: 12849948
references.citation: J Hand Ther. 1993 Oct-Dec;6(4):266-84
references.pmid: 8124441
references.citation: J Hand Ther. 1993 Oct-Dec;6(4):285-9
references.pmid: 8124442