A biomechanical study of pediatric flexor profundus tendon repair. Comparing the tensile strengths of 3 suture techniques
Objectives: To investigate the tensile strength of repaired flexor profundus tendons in young lambs, which would be equivalent to repairs in children older than 2 years of age.
Methods: A comparative in-vitro experimental study conducted at King Saud University, Riyadh, Kingdom of Saudi Arabia from October 2014 to December 2015. We utilized 30 flexor profundus tendons of young lambs with a width of 4 mm. All tendons were repaired with a 4-strand repair technique using 4/0 polypropylene core sutures. In group I (n=10 tendons), 2 separate figure-of-eight sutures were applied. In group II (n=10 tendons), simple locking sutures were added to the corners of 2 separate figure-of-eight sutures. In group III (n=10 tendons), the locked cruciate repair was used. All tendon repairs were tested to single-cycle tensile failure.
Results: There was no significant difference between groups II and III with regards to gap and breaking forces; and all forces of these 2 groups were significantly higher than the forces in group I.
Conclusion: It was concluded that 4 mm-wide pediatric flexor tendons allow a 4-strand repair and the use of 4/0 sutures. The use of locking sutures increases the tensile strength to values that may allow protective mobilization in children.
Saudi Med J 2016; Vol. 37 (9): 957-962
How to cite this article:
Al-Thunayan TA, Al-Zahrani MT, Hakeem AA, Al-Zahrani FM, Al-Qattan MM. A biomechanical study of pediatric flexor profundus tendon repair. Comparing the tensile strengths of 3 suture techniques. Saudi Med J. 2016; 37(9): 957-962. doi: 10.15537/smj.2016.9.15069.
Elliot D. Primary flexor tendon repair--operative repair, pulley management and rehabilitation. J Hand Surg Br 2002; 27: 507-513.
Tang JB. Indications, methods, postoperative motion and outcome evaluation of primary flexor tendon repairs in Zone 2. J Hand Surg Eur Vol 2007; 32: 118-129.
Savage R. The search for the ideal tendon repair in Zone 2: strand number, anchor points and suture techniques. J Hand Surg Eur Vol 2014; 39: 20-29.
Wu YF, Tang JB. Recent developments in flexor tendon repair techniques and factors influencing strength of the tendon repair. J Hand Surg Eur Vol 2014; 39: 6-19.
Al-Qattan MM. Flexor tendon injuries in the child. J Hand Surg Eur Vol 2014; 39: 46-53.
Al-Qattan MM, Mirdad AT, Hafiz MO. Suture purchase length: a biomechanical study of flexor tendon repair in newborn lambs. J Hand Surg Am 2013; 38: 62-65.
Al-Qattan MM, Al-Turaiki TM. Flexor tendon repair in zone 2 using a six-strand ‘figure-of-eight’ suture. J Hand Surg Eur Vol 2009; 34: 322-328.
Barrie KA, Tomak SL, Cholewicki J, Merrell GA, Wolfe SW. Effect of suture locking and suture caliber on fatigue strength of flexor tendon repairs. J Hand Surg Am 2001; 26: 340-346.
Havulinna J, Leppänen OV, Göransson H. The suture loop holding capacity of flexor digitorum profundus tendon within and outside the digital tendon sheath. J Hand Surg Eur Vol 2013; 38: 801-804.
Soejima O, Diao E, Lotz JC, Hariharan JS. Comparative mechanical analysis of dorsal versus palmar placement of core suture for flexor tendon repairs. J Hand Surg Am 1995; 20: 801-807.
Savage R. In vitro studies of a new method of flexor tendon repair. J Hand Surg Br 1985; 10: 135-141.
Robertson GA, Al-Qattan MM. A biomechanical analysis of a new interlock suture technique for flexor tendon repair. J Hand Surg Br 1992; 17: 92-93.
Fitoussi F, Lebellec Y, Frajman JM, Penneçot GF. Flexor tendon injuries in children: factors influencing prognosis. J Pediatr Orthop 1999; 19: 818-821.
Vanhees M, Thoreson AR, Larson DR, Amadio PC, An KN, Zhao C. The effect of suture preloading on the force to failure and gap formation after flexor tendon repair. J Hand Surg Am 2013; 38: 56-61.
Walbeehm ET, De Wit T, Hovius SE, McGrouther DA. Influence of core suture geometry on tendon deformation and gap formation in porcine flexor tendons. J Hand Surg Eur Vol 2009; 34: 190-195.
Peltz TS, Haddad R, Scougall PJ, Nicklin S, Gianoutsos MP, Walsh WR. Influence of locking stitch size in four-strand cross-locked cruciate flexor tendon repair. J Hand Surg Am 2011; 36: 450-455.
Moehrlen U, Mazzone L, Bieli C, Weber DM. Early mobilization after flexor tendon repair in children. Eur J Pediatr Surg 2009; 19: 83-86.
Mishra V, Kuiper JH, Kelly CP. Influence of core suture material and peripheral repair technique on the strength of Kessler flexor tendon repair. J Hand Surg Br 2003; 28: 357-362.
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