Scientific ArticleBiomechanical Analysis of Zone 2 Flexor Tendon Repair With a Coupler Device Versus Locking Cruciate Core Suture
Section snippets
Materials and Methods
We used 5 matched-pair fresh, never-frozen, human cadaver hands. We exposed the flexor sheath of all fingers via a midline volar longitudinal incision from the distal palmar fingertip to the level of the A1 pulley. A rectangular portion of the sheath was excised from the distal A2 pulley edge to the proximal A4 pulley edge. The flexor digitorum profundus (FDP) tendon of each finger was then cut with a scalpel. The location for each cut was standardized with a metal ruler to lie halfway between
Results
All data passed normality and equal variances testing. Coupled and sutured tendons performed similarly for our primary outcome of repair gapping at 2,000 cycles with no clinically relevant mean differences noted (mean gap, 1.27 ± 1.17 mm [SD] vs 0.92 ± 0.67 mm [SD]) respectively. Given the novelty of the coupler device, and lack of previously published or pilot data comparing it with conventional suture repair, post hoc power analysis was performed after initial testing. Post hoc power
Discussion
Given the technical difficulty of consistently achieving a robust flexor tendon repair that enables early motion rehabilitation, the development of a coupler device designed to standardize strong, expeditious repair is intriguing. The recent work of Linnanmäki et al1 highlights an often-overlooked source of variability in hand surgery: technical ability. Differences in surgeon performance introduced the greatest variability in flexor tendon repair load resistance in their biomechanical study.
Acknowledgments
CoNextions Medical (Salt Lake City, UT) donated the coupler repair devices for this study. The company had no control or input for the study design, execution, or manuscript preparation.
This study was funded by The Raymond M. Curtis Research Foundation, The Curtis National Hand Center, Baltimore, MD.
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