Elsevier

The Journal of Hand Surgery

Volume 37, Issue 9, September 2012, Pages 1830-1834
The Journal of Hand Surgery

Scientific article
A Biomechanical Comparison of 3 Loop Suture Materials in a 6-Strand Flexor Tendon Repair Technique

https://doi.org/10.1016/j.jhsa.2012.06.008Get rights and content

Purpose

The braided polyblend (FiberWire) suture is recognized for its superiority in tensile strength in flexor tendon repair. The purpose of this study was to compare the biomechanical performance of 3 loop-suture materials used in a locking 6-strand flexor tendon repair configuration: braided polyblend (FiberLoop 4-0), cable nylon (Supramid Extra II 4-0), and braided polyester (Tendo-Loop 4-0). We hypothesized that, using this technique, the braided polyblend suture would give superior tensile strength compared with the other 2 suture materials.

Methods

We divided 30 fresh porcine flexor tendons transversely and repaired each with 1 of the 3 suture materials using a modified Lim-Tsai 6-strand suture technique. We loaded the repaired tendons to failure using a materials testing machine and collected data on the mechanism of failure, ultimate tensile strength, gap strength, and stiffness.

Results

Failure mechanisms for the repaired specimens were as follows: the braided polyblend had 50% suture breakage and 50% suture pullout; the cable nylon had 100% suture breakage; and the braided polyester had 80% suture breakage and 20% suture pullout. Specimens repaired with the braided polyblend suture had the highest mean ultimate tensile strength (97 N; standard deviation, 22) and the highest mean gap force (35 N; standard deviation, 7).

Conclusions

This study supports the findings of previous studies showing superior strength of the braided polyblend suture.

Clinical relevance

We were able to achieve up to 124 N in ultimate tensile strength and 48 N of gap force with this suture in porcine tendons. This gives greater confidence in starting immediate controlled passive or active rehabilitation after repair of flexor tendon injuries.

Section snippets

Flexor tendon specimens and repair technique

We harvested 30 fresh flexor tendons from the central 2 rays of porcine forelimbs. We then divided the flexor tendons transversely at the level of the A2 pulley and repaired them using a 6-strand, modified version of the Lim-Tsai technique with 1 of the 3 suture materials: (1) cable nylon (Supramid Extra II 4-0; S. Jackson, Inc., Alexandria, VA; n = 10), (2) braided polyester (Tendo-Loop 4-0; B. Braun, Melsungen AG, Germany; n = 10); and (3) braided polyblend (FiberLoop 4-0; FiberWire, Arthrex,

Mechanism of failure

The braided polyblend repairs failed by suture breakage (50%) and suture pullout (50%). All of the cable nylon repairs failed by suture breakage. Most of the braided polyester repairs (80%) failed by suture breakage; the remaining 20% failed by suture pullout. There were no knot failures.

Ultimate tensile strength

Specimens repaired with the braided polyblend suture had the highest mean ultimate tensile strength (97 N; standard deviation [SD] 22), followed by braided polyester (52 N; SD 11) and then cable nylon (47 N; SD

Discussion

Pennington20 first suggested the locking loop suture configuration in 1979 as an effective repair technique for flexor tendons, conferring enough strength for an early mobilization protocol. Pennington also emphasized that the correct orientation of the intratendinous (longitudinal and transverse) components was a critical factor affecting a repair's strength. In 1997, Hotokezaka and Manske21 described locking and grasping suture methods and demonstrated the superiority of the locking suture

References (30)

Cited by (37)

  • Outcomes After Flexor Tendon Repair Combined With the Application of Human Amniotic Membrane Allograft

    2017, Journal of Hand Surgery
    Citation Excerpt :

    Intact vincula were preserved. The technique of the tendon repair was a combination of a core and peripheral sutures: The core suture was 4-0 Fiber-Loop (Arthrex, Naples, FL) locking 6-strand repair, inserted using the Lim-Tsai configuration, modified by Gan et al,14 and the peripheral suture was 5-0 polypropylene suture (Surgipro; Covidien, Minneapolis, MN) using a continuous over-and-over configuration. If both the flexor digitorum profundus (FDP) and the flexor digitorum superficialis (FDS) were transected, the FDP was always repaired, but if the FDS was transected near its distal insertion, only the radial or ulnar slip was repaired with 5-0 polypropylene suture using a mattress suture, and the unrepaired slip was resected.

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Supported by Singhealth Foundation Grant SHF/FG446S/2009 and National Medical Research Council Grants NMRC/1116/2007 and NMRC/1148/2007.

No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.

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