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Updated: Dec 28, 2025
A Novel Tenorrhaphy Suture Technique with Tissue Engineered Collagen Graft to Repair Large Tendon Defects
Published on: December 10, 2021
Tendon With Z-Lengthening Technique and Construct Assessment: A Biomechanical Study for Use in Tendon Reconstructions
William J Weller1, Zach Goldstein2, Fang Li3
1The Indiana Hand to Shoulder Center Indianapolis, Indianapolis, IN.
Purpose:
Tendon reconstruction is frequently required under conditions of tendon deficiency. The authors sought a technique that could obviate the need for tendon harvest yet meet the minimum load of 45 N required for an early active motion protocol. This study was designed to determine the ideal suture construct utilizing the tendon with Z-lengthening (TWZL) technique.
Methods:
Sixty fresh-frozen cadaveric flexor digitorum profundus tendons of the index, middle, and ring fingers were randomized into 5 different TWZL construct designs using 3-0 braided polyethylene suture. Constructs were tested on an electromechanical actuator until failure was observed on the load-elongation recording. Data points on maximum yield and load at 8% strain were recorded for each construct.
Results:
The maximum yield data revealed the construct with a 4-core suture type configuration (construct #4) had the highest overall mean load to failure at 150 N compared with all other constructs. The construct with the highest mean load at 8% strain was that with a 4-core type repair (construct #4) at 59 N. The constructs with Krackow locking sutures (constructs #2, #3, and #4 were found to withstand a significantly higher mean load at 8% strain than those without Krackow sutures (#0 and #1). Comparison among constructs with Krackow locking sutures #2 (56 N), #3 (48 N), and #4 (59 N) did not show a significant difference in mean load at 8% strain. Construct #3, however, had an SD and 95% confidence interval that fell below the 45 N early active motion threshold, whereas both #2 and #4 had 95% confidence intervals that fell no lower than 50 N.
Conclusions:
This study provides evidence that the TWZL technique utilizing either construct #2 or #4 could provide sufficient strength and reproducibility for tendon reconstruction.
Clinical Relevance:
The study describes the application of the TWZL technique for utilization in tendon reconstruction and quantifies differences in the yield strengths of the 5 proposed constructs.
