Further evolution of the grasping technique for tendon repair

Refinement of the modified Kessler tendon-suturing technique is described. The lateral longitudinal limbs of the modified Kessler suture are shifted to a location adjacent to one another in the core of the tendon slightly palmar to the tendon's central axis. This does not compromise the immediate tensile strength of the repair, and eliminates compression of the central portion of the tendon between the two lateral longitudinal limbs of the suture. It also gives rotational freedom to the repair even after the suture is tied, allowing adjustment of the rotational alignment of the tendon ends. These effects are demonstrated using fresh human cadaver digital flexor tendons.