Related Experiment Video
Updated: Jun 24, 2026
A Novel Tenorrhaphy Suture Technique with Tissue Engineered Collagen Graft to Repair Large Tendon Defects
Published on: December 10, 2021
Comparison of 1- and 2-knot, 4-strand, double-modified kessler tendon repairs in a porcine model
Leila Rees1, April Matthews, Spyridon D Masouros
1Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospital, Norwich, Norfolk, UK. leilarees24@hotmail.com
Purpose:
To compare 1- and 2-knot, 4-strand, double-modified Kessler tendon repairs. It was our hypothesis that a 1-knot technique using an unbraided suture material would be stronger if it is possible for some movement to occur between strands on loading, redistributing forces such that the load is equally shared.
Methods:
Fifty-six porcine flexor tendons were allocated to either a 1- or 2-knot, 4-strand, double-modified Kessler repair, and tested by incremental cyclical loading in vitro.
Results:
The 1-knot technique was significantly stronger. Gap formation was initially greater in the 1-knot group, consistent with movement of strands, but with increasing physiological levels of applied force, there was no significant difference between the groups.
Conclusions:
The 1-knot technique was significantly stronger than the 2-knot technique.
