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Updated: Mar 15, 2026

Polytetrafluoroethylene PTFE as a Suture Material in Tendon Surgery
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Flexor Hallucis Longus Tendon Transfer Fixation.

Jessica Lee1, Chad Williams1, Charles Lowrey1

  • 1Wright State University Boonshoft School of Medicine, Dayton, Ohio.

Foot & Ankle Specialist
|September 9, 2016
PubMed
Summary
This summary is machine-generated.

A terminal whipstitch significantly enhances Flexor Hallucis Longus (FHL) tendon transfer fixation strength. Tunnel depth did not impact pull-out strength in synthetic models, suggesting partial tunnels are a viable option.

Keywords:
Achilles tendinopathyAchilles tendon (AT)Arthrex Bio-Tenodesis Screwflexor hallucis longus (FHL)

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Area of Science:

  • Orthopedic Surgery
  • Biomechanical Engineering
  • Sports Medicine

Background:

  • Chronic Achilles tendinopathy often necessitates Flexor Hallucis Longus (FHL) tendon transfer to the calcaneus.
  • Assessing the biomechanical integrity of FHL tendon biotenodesis screw fixation is crucial for surgical outcomes.

Purpose of the Study:

  • To evaluate the impact of a terminal whipstitch and tunnel depth on FHL tendon biotenodesis screw fixation strength.
  • To compare fixation integrity in synthetic bone models versus cadaveric bone.

Main Methods:

  • Sixty cadaver FHL tendons and 28 calcanei were used to create fixation constructs.
  • Pull-out strength testing compared whipstitched versus non-whipstitched tendons and full-depth versus partial-depth tunnels in synthetic and cadaveric bone.

Main Results:

  • Whipstitched tendons showed significantly greater mean clinical and maximum load to failure in synthetic bone (P = .008 and P = .001, respectively).
  • No significant differences in pull-out strength were observed between full-depth and partial-depth tunnels in synthetic bone (P = .63 and P = .73).
  • No significant differences were found in cadaveric bone trials.

Conclusions:

  • Incorporating a terminal whipstitch enhances the fixation strength of FHL tendon biotenodesis.
  • Both complete and partial tunnel constructs exhibit comparable pull-out strength.
  • The whipstitch technique offers biomechanical superiority, and partial tunnels are non-inferior in fixation strength.