Mechanical strengths of tendon sutures. An in vitro comparative study of six techniques

A comparative study of six tendon suturing techniques (1. Modified Kessler + simple epitendinous running suture; 2. Modified Kessler + Halsted epitendinous suture; 3. "Six strand" suture; 4. "Interlocking" suture; 5. "Cross stitch" suture; 6. simple epitendinous running suture) was carried out by evaluating strength in relation to the beginning of separation between the tendon stumps, a 3 mm separation and rupture in porcine flexor tendons. The technique most resistant to initial separation was the modified Kessler + Halsted epitendinous suture followed by the "Six strand" suture. The "Six strand" suture was the most resistant to the 3 mm separation and rupture followed by the modified Kessler + Halsted epitendinous suture. Despite the greater resistance to rupture of the "Six strand" technique, we conclude that modified Kessler + Halsted epitendinous suture showed the best overall performance and was easier to use.