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Biomechanical Study of Modified Massachusetts General Hospital Flexor Tendon Repair Using Looped Sutures.

Qiao Wang¹, Yoke Rung Wong², Duncan Angus McGROUTHER^1,2

¹Department of Hand Surgery and Reconstructive Microsurgery, Singapore General Hospital, Singapore.

The Journal of Hand Surgery Asian-Pacific Volume

|July 9, 2022

Summary

The modified looped Massachusetts General Hospital (MGH) repair technique offers a faster and equally strong or stronger alternative to the original MGH repair for flexor tendons. Different looped sutures provide varied biomechanical advantages.

Keywords:

Biomechanical study Flexor tendon laceration Looped MGH repair Looped suture Massachusetts General Hospital (MGH) repair

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Area of Science:

Orthopedic Surgery
Biomedical Engineering
Tendon Repair Biomechanics

Background:

The Massachusetts General Hospital (MGH) repair is a common 4-strand flexor tendon repair method.
The original MGH repair utilizes two single-strand sutures, potentially leading to time inefficiency and load imbalance.
A modified 'looped MGH repair' using a single looped suture was developed to address these limitations.

Purpose of the Study:

To compare the biomechanical strength and efficiency of the modified looped MGH repair against the original MGH repair.
To evaluate three different looped suture materials (Supramid®, Tendo-Loop®, FiberLoop®) in the modified repair technique.

Main Methods:

Forty porcine flexor tendons were used for biomechanical testing.
Repairs were performed using the original MGH technique (Prolene® 4-0) and the looped MGH technique with Supramid® 4-0, Tendo-Loop® 4-0, and FiberLoop® 4-0.
Key parameters measured included ultimate tensile strength, stiffness, load to 2-mm gap formation, and repair time.

Main Results:

No significant biomechanical difference was found between the original MGH repair and the looped MGH repair using Supramid®.
Looped MGH repairs with Tendo-Loop® and FiberLoop® demonstrated significantly higher ultimate tensile strength.
FiberLoop® exhibited the highest load to 2-mm gap formation, and all looped repairs were significantly faster than the original.

Conclusions:

The looped MGH repair with Supramid® 4-0 offers comparable strength to the original MGH repair with Prolene® 4-0, but with reduced repair time.
Utilizing FiberLoop® 4-0 in the looped MGH repair provides enhanced strength and efficiency compared to the original technique.