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Updated: Sep 3, 2025
Using Q Suture to Enhance Resistance to Gap Formation and Tensile Strength of Repaired Flexor Tendons
Published on: June 3, 2020
Loop diameter of a modified Kessler locking-loop suture affects in vitro tensile strength and gapping characteristics
Yi-Jen Chang1, Daniel J Duffy1, George E Moore2
1Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC.
Objective:
To evaluate effects of loop diameter of a modified Kessler locking-loop (LL) suture on in vitro tensile strength and gapping characteristics of canine flexor tendon repairs.
Sample:
48 cadaveric superficial digital flexor tendons from 24 adult medium- to large-breed dogs.
Procedures:
Flexor tendons were randomly assigned to 4 groups (n = 12/group) and repaired with 2-0 polypropylene in a LL pattern with loops measuring 1, 2, 3, or 4 mm in diameter. Biomechanical loads, gap formation between tendon ends, and failure modes were evaluated and compared between groups.
Results:
Increasing loop diameter from 1 to 4 mm significantly increased yield (P = .048), peak (P < .001), and failure (P < .001) loads. There were no significant differences in yield, peak, and failure loads between 1- and 2-mm loops. Load to 3-mm gap formation was significantly (P < .001) greater for 4-mm loops, compared with 1-, 2-, and 3-mm loops. Failure mode did not differ significantly among experimental groups, with 46 of 48 (96%) of constructs failing because of suture breakage.
Clinical Relevance:
Loop diameter of a LL suture pattern is an important biomechanical variable that influences construct biomechanics of canine tendon suture repairs. Loop diameters > 3 mm are recommended when the size of the tendon allows. Further studies are necessary to determine the in vivo effect of these findings, particularly the effects on tendon blood supply.
