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Epitendinous suture techniques in extensor tendon repairs--an experimental evaluation.

James Henderson¹, Michael Sutcliffe, Patrick Gillespie

¹Department of Plastic and Reconstructive Surgery, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK. jh@jameshenderson.net

The Journal of Hand Surgery

|November 1, 2011

Summary

The interrupted horizontal mattress (IHM) extensor tendon repair demonstrated superior strength and resistance to gapping compared to Silfverskiöld and Halsted techniques in vitro. Further clinical studies are needed to confirm its benefits.

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Area of Science:

Orthopedic surgery
Biomechanical engineering
Tendon repair research

Background:

The tension-band principle is crucial for extensor tendon repairs.
Dorsal-only Silfverskiöld epitendinous repair shows superior strength and stiffness in vitro compared to conventional methods.
Evaluating novel suture techniques for enhanced extensor tendon repair strength is essential.

Purpose of the Study:

To assess the strength and stiffness of various epitendinous sutures.
To compare the performance of dorsal-only Silfverskiöld, reverse Silfverskiöld, Halsted, and interrupted horizontal mattress (IHM) repairs.
To utilize an in vitro tension-band model simulating angular force over a pulley.

Main Methods:

Porcine foot tendons underwent four types of extensor tendon repairs: Silfverskiöld dorsal-only, reverse Silfverskiöld, Halsted, and IHM.

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Repairs were tested in vitro using a tensiometer around a 45° pulley to simulate tension.

Key metrics included the force required for 2-mm gapping and ultimate tensile strength.

Main Results:

The IHM repair exhibited significantly higher ultimate tensile strength (43 N) compared to other methods (27–31 N).
IHM repairs were significantly more resistant to gapping than Silfverskiöld and Halsted repairs.
All tested repairs showed considerable strength and gapping resistance relative to existing literature.

Conclusions:

Interlocking horizontal mattress (IHM) dorsal-only extensor tendon repairs are significantly stronger and more resistant to gapping than Silfverskiöld and Halsted repairs.
While IHM offers superior biomechanical properties, its technical difficulty may impact clinical adoption.
The clinical relevance of IHM's enhanced strength requires further investigation compared to simpler techniques like Silfverskiöld.