A randomized biomechanical study of zone II human flexor tendon repairs analyzed in a linear model

Komanduri et al showed that dorsal tendon repairs using Kessler and Bunnell techniques were stronger than the standard volar repair (J Hand Surg 1996;21 A:605-611). They concluded that when testing in the anatomic curvilinear mode, the differences in strength were due to tension banding. Soejima et al challenged that concept by stating that the difference in strength was in the biomechanics of the dorsal tendon itself (J Hand Surg 1995;20A:801-807). We set out to confirm Soejima et al's theory by using more core suture techniques. We compared the tensile strength at 2-mm gap and the ultimate tensile strength of Kessler, Strickland, Robertson, and modified Becker sutures. Ten repairs of each suture type were placed either dorsally or volarly in matched human cadaver flexor tendons. There was no statistical difference between volar and dorsal placement for either maximum tensile force or force at 2-mm gap. Our study does not confirm Soejima et al's in any of the four suturing techniques.