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Related Experiment Video

Updated: Feb 17, 2026

A Novel Tenorrhaphy Suture Technique with Tissue Engineered Collagen Graft to Repair Large Tendon Defects
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Tendon Stapler Device Versus Traditional Suture Repair for Flexor Tendon Injuries: A Biomechanical Comparison.

Richard W McKinney1, Anna Barclay1, Jacob Sneddon1

  • 1Allegheny Health Network, Pittsburgh, PA, USA.

Hand (New York, N.Y.)
|February 16, 2026
PubMed
Summary

Tendon stapler devices (TSDs) demonstrated superior strength compared to traditional 4-strand locked cruciate suture repairs for flexor tendons in cadaveric testing. Further research is needed to confirm clinical benefits.

Keywords:
basic sciencebiomechanicsflexor tendontendontendon injurytendon repairtendon stapler

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Area of Science:

  • Orthopedic surgery
  • Biomechanical engineering
  • Hand surgery

Background:

  • Flexor tendon injuries present significant surgical challenges.
  • Traditional suture repair methods, like the 4-strand locked cruciate stitch, are effective but technically demanding.
  • Tendon stapler devices (TSDs) offer a potentially faster, stronger, and lower-profile repair option.

Purpose of the Study:

  • To compare the biomechanical strength of Tendon Stapler Device (TSD) repairs versus 4-strand locked cruciate suture repairs in cadaveric flexor tendons.
  • To evaluate load to failure and load at 2-mm gap formation for both repair techniques.

Main Methods:

  • Twenty-four cadaveric flexor tendons were divided into two groups: 12 suture repairs (3-0 braided composite suture) and 12 TSD repairs (CoNextions devices).
  • Repaired tendons were tested on a uniaxial load frame to determine maximum tension and tension at 2-mm gap formation.
  • Statistical analysis using independent t-tests compared the biomechanical properties of the two repair methods.

Main Results:

  • TSD repairs exhibited a significantly higher mean load to failure (70.6 ± 20.5 N) compared to suture repairs (49.9 ± 14.1 N).
  • The mean load to 2-mm gap formation was also significantly greater for TSD repairs (57.5 ± 21.1 N) than for suture repairs (38.6 ± 13.7 N).

Conclusions:

  • Tendon stapler device (TSD) repairs provide superior strength over 4-strand locked cruciate suture repairs in cadaveric flexor tendons.
  • While TSDs show promising biomechanical advantages, further clinical studies and cost-effectiveness analyses are warranted before widespread adoption.