Knotless Tenorrhaphy of Cadaveric Zone 2 Flexor Digitorum Profundus Tendons

Barbed suture allows for a knotless tenorrhaphy, which could provide an expedient method of flexor tendon repair while limiting cross-sectional area (CSA) following repair.

Fifty-one cadaveric flexor digitorum profundus tendons were procured based on an a priori sample size estimate. Specimens were randomized to either one of three 6-strand repair techniques (3-0 braided polyester Savage repair, 2-0 strength polypropylene barbed suture repair, and 4-0 looped nylon M-Tang repair). Length of time to complete each repair and cost of material was recorded. The long and short axes of the repair site were measured to calculate the CSA. An Instron loaded the constructs to 2-mm gapping and load to failure. Differences between long and short axes and CSA prior to tenotomy and post-tenorrhaphy were measured and compared for change.

Repair time for the Savage technique was significantly longer and provided significantly greater loads to 2-mm gapping and failure. Material cost with the Savage repair was significantly less than repairs with the other materials, whereas material cost with the barbed suture was significantly less than the material cost of the M-Tang repair. There were no significant differences between the 3 groups regarding change in long axis, short axis, or CSA measurements after repair.

The Savage repair provided the greatest strength, with a lower suture cost, but a greater repair time. Barbed suture repair performed similar to the M-Tang repair at a lower material cost.