The 2003 Annual Meeting of OASYS_NEW

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Reduction Flexor Tenoplasty for Repair of the Flexor Tendon Using Large Core Suture: a Biomechanical Cadaver Study

Seradge H, Orthopaedic & Reconstructive Research Foundation, 1044 S.W. 44th, Suite 403, Oklahoma City, OK, USA, Tian W, Department of Hand Surgery, Beijing Ti Shui Tan Hospital, Beijing, China, Owen W, Dept. of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, 801 N.E. 13th Street, Oklahoma City, OK, USA, and Baer C, The Therapy Center, 1044 S.W. 44th, Suite 300, Oklahoma City, OK, USA.

PURPOSE OF STUDY: Strength of a flexor tendon repair is directly related to the strength of the suture used. A large core suture is stronger than a small core suture; however, the large knot it creates at the repair site makes it unacceptable. We investigated a procedure to accommodate a bulky knot so a large core suture can be used to repair a flexor tendon.

METHODOLOGY / DESIGN: Twenty fresh frozen cadaver flexor digitorum profundi were sharply cut and divided into two groups. The tendons of both groups were repaired using a #0 polyester suture with the modified Kessler repair technique and epitenon repair. In the second group, the tendon was debulked at the knot site using the reduction flexor tenoplasty procedure (JHS, 1981). Then the knot was buried inside the debulked tendon and the epitonon was repaired. The repaired tendons of both groups were loaded to failure on a material testing system machine (MTS-810). The load to gap initiation, 2mm gap formation and ultimate failure were electronically plotted and the mode of failure was digitally recorded.

RESULTS: 1) No repaired tendon failed at the reduction flexor tenoplasty site. 2) The average tensile strength property of each flexor tendon repair was similar with or without reduction flexor tenoplasty. 3) The total diameter of the tendon with the buried bulky knot was smaller than the diameter of the repaired tendon with the knot outside. 4) The tensile strength to gap initiation, 2mm gap formation and failure (SD±) were as follows:

REPAIR TECHNIQUE/GAP FORMATION/2mm GAP FORMATION/FAILURE

Modified Kessler: 28.3 ± 2.5/41.6 ± 3.5/65.8 ± 3.0

Modified Kessler and reduction flexor tenoplasty: 26.8 ± 3.1/42.7 ± 2.9/66.9 ± 2.8

5) The mode of physical failure at the repair site was similar in both groups. The ultimate physical failure of the repaired tendon was due to suture breakage or pull out and not due to failure at the reduction flexor tenoplasty site. CONCLUSION: 1) A large core suture material can be used for repairing a flexor tendon using reduction flexor tenoplasty. 2) Reduction flexor tenoplasty can be used without reducing the tensile strength of the repaired tendon. 3) Reduction flexor tenoplasty allows using a large core suture for flexor tendon repair without its unwanted effects of a large knot. 4) Reduction flexor tenoplasty was proven biomechanically safe for flexor tendon repairs in a cadaver study.


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