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Updated: May 15, 2026
Using Q Suture to Enhance Resistance to Gap Formation and Tensile Strength of Repaired Flexor Tendons
Published on: June 3, 2020
The effect of suture preloading on the force to failure and gap formation after flexor tendon repair
Matthias Vanhees1, Andrew R Thoreson, Dirk R Larson
1Biomechanics Laboratory, Division of Orthopedic Research, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA.
Purpose:
Gap formation is a common and severe complication after flexor tendon repair that can affect the outcome and prolong tendon healing. The purpose of this study was to investigate the effect that a pretensional force applied to the suture during tendon repair has on the repair strength and force that causes gap formation.
Methods:
We used a total of 48 flexor digitorum profundus tendons from 12 human cadaver hands. We employed a core tendon suture, using the modified Pennington technique, and a running suture for flexor tendon repair. Before tying the knots of the core suture, we preloaded the sutures in each tendon end 0, 5, 10, or 15 N for 10 seconds to compare the effect of loading magnitude on repaired tendon peak force to failure and force causing gap formation.
Results:
The force to form a gap of 2 mm in the 15-N preload group was significantly increased compared with the 0-N and 5-N preload groups. At the 3-mm gap formation, the force of all preload groups was significantly higher than the nonpreload group. The peak force with a preload of 10 N and 15 N was significantly higher than 0-N preload.
Conclusions:
These findings suggest that pretensioning with 10 to 15 N at the suture-tendon interface before tying the knot has a beneficial effect on both the tendon gap formation and the peak force to failure.
Clinical Relevance:
When the surgeons perform tendon repair, pretensioning at the suture-tendon conjunction will increase the repair strength.
