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Published on: December 10, 2021
A 3-Dimensional Suture Technique for Flexor Tendon Repair: A Biomechanical Study
Marie Castoldi1, Federico Solla2, Olivier Camuzard3
1Orthopaedic Surgery, Lenval University Children's Hospital, Nice, France; Medical School, Institute of Musculoskeletal Surgery, University of Nice, Nice, France; Aix-Marseille University, CNRS, ISM, Marseille, France.
The 3-dimensional (3D) suture technique with ultrahigh molecular weight polyethylene (UHMWPE) offers superior mechanical strength for flexor tendon repair compared to the Adelaide technique. This 3D repair method improves tensile strength and gap force, aiding early rehabilitation.
Area of Science:
- Orthopedic Surgery
- Biomaterials Science
- Hand Surgery
Background:
- Flexor tendon injuries present significant challenges in hand surgery.
- Enhanced mechanical properties of tendon repairs are crucial for enabling earlier, unprotected rehabilitation.
- A novel 3-dimensional (3D) 4-strand suture technique aims to improve tensile strength and reduce gliding resistance, preventing suture pullout.
Purpose of the Study:
- To evaluate and compare the mechanical properties of the 3D suture technique against the Adelaide technique for flexor tendon repair.
- To determine if the 3D technique offers superior tensile strength and gap force compared to the Adelaide technique.
Main Methods:
- Porcine flexor tendons were divided into four groups (n=10 each).
- Tendons were repaired using either the 3D or Adelaide technique with either polypropylene or ultrahigh molecular weight polyethylene (UHMWPE) suture.
- Axial traction tests were conducted to measure 2-mm gap force and ultimate tensile strength.
Main Results:
- The 3D technique with UHMWPE suture achieved a mean 2-mm gap force of 145 N, significantly higher than the Adelaide technique (80 N).
- Ultimate tensile strength was superior with the 3D technique (145 N) compared to the Adelaide technique (80 N) when using UHMWPE suture.
- Failure modes varied, with suture pullout being more prevalent in the Adelaide technique groups.
Conclusions:
- The 3D suture technique, particularly with UHMWPE suture, demonstrates superior mechanical properties for flexor tendon repair in vitro.
- Repairs using the 3D technique and UHMWPE suture exceeded a 140 N threshold for both gap force and tensile strength.
- The 3D technique shows promise for improving outcomes in flexor tendon repair, potentially allowing for more aggressive rehabilitation protocols.
