Transosseous Sutures in Tendon-to-Bone Repairs: the Role of the Epitendinous Suture
Background: Numerous transosseous fixation techniques for flexor tendon injuries in Zone 1 of the hand have been described in the literature. While relatively high maximal loads to failure are documented in different biomechanical experiments, several tests revealed a low 2 mm gapping resistance of...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2022-02-01
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| Series: | Journal of Investigative Surgery |
| Subjects: | |
| Online Access: | http://dx.doi.org/10.1080/08941939.2021.1904464 |
| _version_ | 1827817172039106560 |
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| author | Samuel M. Christen Jörg G. Gruenert Patrick S. Harenberg |
| author_facet | Samuel M. Christen Jörg G. Gruenert Patrick S. Harenberg |
| author_sort | Samuel M. Christen |
| collection | DOAJ |
| description | Background: Numerous transosseous fixation techniques for flexor tendon injuries in Zone 1 of the hand have been described in the literature. While relatively high maximal loads to failure are documented in different biomechanical experiments, several tests revealed a low 2 mm gapping resistance of the tendon-to-bone repairs. We therefore aimed to investigate the effect on gap formation adding a peripheral suture to an established transosseous fixation technique. In addition, we analyzed the influence of different suture materials (braided vs. non-braided) on the stability of the core suture. Method: A total of 30 porcine flexor digitorum profundus tendons were divided into 3 groups (n = 10 each) and repaired using the transverse intraosseous loop technique (TILT). In group 1 and group 2 the repairs were performed using PDS 3-0 or Ethibond 3-0, respectively. In group 3, a peripheral suture was added to the core suture (PDS 3-0) consisting of two figure-of-eight stitches with PDS 5-0. The biomechanical performance of the repaired tendons was analyzed using a standardized protocol. Results: The suture material and peripheral suture showed no effect on the ultimate failure load in our testing. However, the addition of a peripheral suture led to a statistically significantly higher 2 mm gap force when compared with the repair with a core suture only. Conclusion: In conclusion, addition of a palmar epitendinous suture to the transosseous core suture significantly increases the load to 2 mm gap formation in Zone 1 flexor tendon repairs and thus allows an immediate controlled mobilization. |
| first_indexed | 2024-03-12T00:30:37Z |
| format | Article |
| id | doaj.art-dbcb4f62a5914a2392569ebc8cecd0c2 |
| institution | Directory Open Access Journal |
| issn | 0894-1939 1521-0553 |
| language | English |
| last_indexed | 2024-03-12T00:30:37Z |
| publishDate | 2022-02-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Journal of Investigative Surgery |
| spelling | doaj.art-dbcb4f62a5914a2392569ebc8cecd0c22023-09-15T10:21:28ZengTaylor & Francis GroupJournal of Investigative Surgery0894-19391521-05532022-02-0135358459010.1080/08941939.2021.19044641904464Transosseous Sutures in Tendon-to-Bone Repairs: the Role of the Epitendinous SutureSamuel M. Christen0Jörg G. Gruenert1Patrick S. Harenberg2Department of Hand, Plastic and Reconstructive Surgery, Kantonsspital St. GallenDepartment of Hand, Plastic and Reconstructive Surgery, Kantonsspital St. GallenDepartment of Plastic Surgery, BG University Hospital BergmannsheilBackground: Numerous transosseous fixation techniques for flexor tendon injuries in Zone 1 of the hand have been described in the literature. While relatively high maximal loads to failure are documented in different biomechanical experiments, several tests revealed a low 2 mm gapping resistance of the tendon-to-bone repairs. We therefore aimed to investigate the effect on gap formation adding a peripheral suture to an established transosseous fixation technique. In addition, we analyzed the influence of different suture materials (braided vs. non-braided) on the stability of the core suture. Method: A total of 30 porcine flexor digitorum profundus tendons were divided into 3 groups (n = 10 each) and repaired using the transverse intraosseous loop technique (TILT). In group 1 and group 2 the repairs were performed using PDS 3-0 or Ethibond 3-0, respectively. In group 3, a peripheral suture was added to the core suture (PDS 3-0) consisting of two figure-of-eight stitches with PDS 5-0. The biomechanical performance of the repaired tendons was analyzed using a standardized protocol. Results: The suture material and peripheral suture showed no effect on the ultimate failure load in our testing. However, the addition of a peripheral suture led to a statistically significantly higher 2 mm gap force when compared with the repair with a core suture only. Conclusion: In conclusion, addition of a palmar epitendinous suture to the transosseous core suture significantly increases the load to 2 mm gap formation in Zone 1 flexor tendon repairs and thus allows an immediate controlled mobilization.http://dx.doi.org/10.1080/08941939.2021.1904464flexor tendon repairtransosseous sutureepitendinous suturebiomechanical testingtendon rupture zone 12 mm gap forcetendon-to-bone repair |
| spellingShingle | Samuel M. Christen Jörg G. Gruenert Patrick S. Harenberg Transosseous Sutures in Tendon-to-Bone Repairs: the Role of the Epitendinous Suture Journal of Investigative Surgery flexor tendon repair transosseous suture epitendinous suture biomechanical testing tendon rupture zone 1 2 mm gap force tendon-to-bone repair |
| title | Transosseous Sutures in Tendon-to-Bone Repairs: the Role of the Epitendinous Suture |
| title_full | Transosseous Sutures in Tendon-to-Bone Repairs: the Role of the Epitendinous Suture |
| title_fullStr | Transosseous Sutures in Tendon-to-Bone Repairs: the Role of the Epitendinous Suture |
| title_full_unstemmed | Transosseous Sutures in Tendon-to-Bone Repairs: the Role of the Epitendinous Suture |
| title_short | Transosseous Sutures in Tendon-to-Bone Repairs: the Role of the Epitendinous Suture |
| title_sort | transosseous sutures in tendon to bone repairs the role of the epitendinous suture |
| topic | flexor tendon repair transosseous suture epitendinous suture biomechanical testing tendon rupture zone 1 2 mm gap force tendon-to-bone repair |
| url | http://dx.doi.org/10.1080/08941939.2021.1904464 |
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