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Updated: Apr 20, 2026
A Novel Tenorrhaphy Suture Technique with Tissue Engineered Collagen Graft to Repair Large Tendon Defects
Published on: December 10, 2021
Biomechanical analysis of flexor tendon repair using knotted Kessler and Bunnell techniques and the knotless Bunnell
Martin C Jordan1, Karsten Schmidt1, Rainer H Meffert1
1Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital, Würzburg, Germany.
Purpose:
To evaluate a knotless Bunnell suture in flexor tendon repair.
Methods:
Eighty porcine flexor digitorum tendons were assigned to 4 different suture techniques. Group 1 was repaired using a modified 4-strand knotted Kessler suture and served as a control group. Group 2 was repaired using a 4-strand knotted Bunnell suture. Group 3 used a 4-strand knotless Bunnell suture. Group 4 used a 4-strand knotless Bunnell and knotless peripheral suture. Under static and cyclic testing we studied mode of failure, 2-mm gap formation force, displacement, and maximum load.
Results:
The 4-strand knotless Bunnell suture did not show a notable difference with regard to 2-mm gap formation force, displacement, or maximum load in comparison to the modified 4-strand knotted Kessler suture. Adding a knotless peripheral suture improved the repair by a significant reduction of gap formation and displacement and an increase in maximum load. The 4-strand knotted Bunnell showed the highest maximum load but also a considerable lower resistance to gap formation and major displacement.
Conclusions:
Flexor tendon repair using a 4-strand knotless Bunnell suture showed similar tensile strength to a modified 4-strand knotted Kessler suture. Adding a knotless peripheral suture further improved the repair.
Clinical Relevance:
A complete knotless 4-strand Bunnell suture including a barbed core- and peripheral suture might be an option for flexor tendon reconstruction.
