TY - JOUR
T1 - The effect of suture caliber and number of core suture strands on zone II flexor tendon repair
T2 - A study in human cadavers
AU - Osei, Daniel A.
AU - Stepan, Jeffrey G.
AU - Calfee, Ryan P.
AU - Thomopoulos, Stavros
AU - Boyer, Martin I.
AU - Potter, Ryan
AU - Gelberman, Richard H.
N1 - Funding Information:
This publication was supported by grants from the National Institutes of Health ( AR062947, R.H.G. and S.T .) and the Washington University Institute of Clinical and Translational Sciences ( UL1 TR000448, D.A.O .), from the National Center for Advancing Translational Sciences. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
PY - 2014/2
Y1 - 2014/2
N2 - Purpose To compare the tensile properties of a 3-0, 4-strand flexor tendon repair with a 4-0, 4-strand repair and a 4-0, 8-strand repair. Methods Following evaluation of the intrinsic material properties of the 2 core suture calibers most commonly used in tendon repair (3-0 and 4-0), we tested the mechanical properties of 40 cadaver flexor digitorum profundus tendons after zone II repair with 1 of 3 techniques: a 3-0, 4-strand core repair, a 4-0, 8-strand repair, or a 4-0, 4-strand repair. We compared results across suture caliber for the 2 sutures and across tendon repair methods. Results Maximum load to failure of 3-0 polyfilament caprolactam suture was 49% greater than that of 4-0 polyfilament caprolactam suture. The cross-sectional area of 3-0 polyfilament caprolactam was 42% greater than that of 4-0 polyfilament caprolactam. The 4-0, 8-strand repair produced greater maximum load to failure when compared with the 2 4-strand techniques. Load at 2-mm gap, stiffness, and work to yield were significantly greater in the 4-0, 8-strand repair than in the 3-0, 4-strand repair. Conclusions In an ex vivo model, an 8-strand repair using 4-0 suture was 43% stronger than a 4-strand repair using 3-0 suture, despite the finding that 3-0 polyfilament caprolactam was 49% stronger than 4-0 polyfilament caprolactam. These results suggest that, although larger-caliber suture has superior tensile properties, the number of core suture strands across a repair site has an important effect on time zero, ex vivo flexor tendon repair strength. Clinical relevance Surgeons should consider using techniques that prioritize multistrand core suture repair over an increase in suture caliber.
AB - Purpose To compare the tensile properties of a 3-0, 4-strand flexor tendon repair with a 4-0, 4-strand repair and a 4-0, 8-strand repair. Methods Following evaluation of the intrinsic material properties of the 2 core suture calibers most commonly used in tendon repair (3-0 and 4-0), we tested the mechanical properties of 40 cadaver flexor digitorum profundus tendons after zone II repair with 1 of 3 techniques: a 3-0, 4-strand core repair, a 4-0, 8-strand repair, or a 4-0, 4-strand repair. We compared results across suture caliber for the 2 sutures and across tendon repair methods. Results Maximum load to failure of 3-0 polyfilament caprolactam suture was 49% greater than that of 4-0 polyfilament caprolactam suture. The cross-sectional area of 3-0 polyfilament caprolactam was 42% greater than that of 4-0 polyfilament caprolactam. The 4-0, 8-strand repair produced greater maximum load to failure when compared with the 2 4-strand techniques. Load at 2-mm gap, stiffness, and work to yield were significantly greater in the 4-0, 8-strand repair than in the 3-0, 4-strand repair. Conclusions In an ex vivo model, an 8-strand repair using 4-0 suture was 43% stronger than a 4-strand repair using 3-0 suture, despite the finding that 3-0 polyfilament caprolactam was 49% stronger than 4-0 polyfilament caprolactam. These results suggest that, although larger-caliber suture has superior tensile properties, the number of core suture strands across a repair site has an important effect on time zero, ex vivo flexor tendon repair strength. Clinical relevance Surgeons should consider using techniques that prioritize multistrand core suture repair over an increase in suture caliber.
KW - Core suture
KW - flexor tendon repair
KW - intrasynovial
KW - multistrand repair
KW - zone II
UR - http://www.scopus.com/inward/record.url?scp=84895071552&partnerID=8YFLogxK
U2 - 10.1016/j.jhsa.2013.11.001
DO - 10.1016/j.jhsa.2013.11.001
M3 - Article
C2 - 24342261
AN - SCOPUS:84895071552
SN - 0363-5023
VL - 39
SP - 262
EP - 268
JO - Journal of Hand Surgery
JF - Journal of Hand Surgery
IS - 2
ER -