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Biomechanical study comparing Pulvertaft suture to step-cut suture.

A Duprat¹, L-E Gayet¹, C Breque¹

¹Service d'orthopédie traumatologie, CHU de Poitiers, rue de la Miletrie, BP 577, 86021 Poitiers cedex, France.

Hand Surgery & Rehabilitation

|December 18, 2017

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The step-cut suture offers a thinner and stronger flexor tendon repair than the Pulvertaft weave, facilitating early active mobilization in hand reconstructions. This method may reduce fibrosis and improve functional outcomes.

Area of Science:

Orthopedic Surgery
Hand Surgery
Biomedical Engineering

Background:

Tendon grafts are crucial for chronic flexor tendon injuries, particularly in two-stage Hunter reconstruction.
Evaluating repair techniques is essential for optimizing early active mobilization after flexor tendon reconstruction.

Purpose of the Study:

To compare the biomechanical strength of the Pulvertaft weave versus the step-cut suture for flexor tendon reconstruction.
To assess the suitability of these repair methods for enabling early active mobilization.

Main Methods:

A biomechanical study using 30 cadaver hands.
Randomized assignment of flexor digitorum profundus and palmaris longus tendons to either Pulvertaft weave or step-cut suture groups.
Evaluation of failure load, cross-sectional area (CSA), and tensile strength of the repairs.

Keywords:

Biomechanics Biomécanique Flexor tendon Greffe tendineuse Reconstruction Tendon fléchisseur Tendon graft

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Main Results:

No significant difference in failure load between the Pulvertaft weave (116N) and step-cut suture (103N) groups.
The step-cut suture group exhibited a significantly smaller CSA (19.8mm²) compared to the Pulvertaft group (35mm²).
The step-cut suture group demonstrated significantly higher tensile strength (5.3N/mm²) than the Pulvertaft group (3.4N/mm²).

Conclusions:

The step-cut suture provides a repair that is both strong enough (exceeding the 75N minimum for early mobilization) and thinner, potentially reducing fibrosis.
This technique may lead to better functional results in flexor tendon reconstruction.
Further research is needed to define anatomical criteria for using the palmaris longus tendon, especially when it is thin or weak.