1
|
Brenac C, Pithioux M, Tomczak S, Lallemand M, Jaloux C, de Villeneuve Bargemon JB. Biomechanical evaluation of the ST-knot: A new suture for flexor tendon repair. HAND SURGERY & REHABILITATION 2024; 43:101650. [PMID: 38301768 DOI: 10.1016/j.hansur.2024.101650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 02/03/2024]
Abstract
PURPOSE Although tendon lacerations are common, there is currently no consensus on choice of suture. Easy and fast sutures that impart enough strength to allow mobilization are needed. This study compared the ex vivo biomechanical strength (force required to create a 2 mm tendon gap) of a novel suture (ST-knot) with that of a conventional suture (double Kessler). MATERIALS AND METHODS Forty fresh deep flexor tendons from porcine forelimbs were used. Both repaired tendon ends were mounted on standard traction jaws of an axial traction machine at an initial distance of 40 mm for all tendons. A high-definition camera was used to determine the force forming a 2 mm gap. Ten tendons in group 1 (ST-knot) and 10 in group 2 (double Kessler) were prepared with PDS 4.0 (single thread for Kessler, double thread for ST-knot). Tendons in groups 3 (ST-knot) and 4 (double Kessler) were repaired with PDS 1.0 using the same principle. RESULTS There was no significant difference in the force required to form a 2 mm tendon gap between groups 1 and 2, and this trend was identical when using a stronger thread in groups 3 and 4. The maximum force before rupture, mode of repair failure, stress and stiffness were also comparable, with no significant differences between groups 1 and 2, or between groups 3 and 4. CONCLUSIONS The ST-knot showed comparable results to the double-Kessler knot, whichever the thread used. Because it involves fewer steps than conventional techniques and is easy to perform, the ST-knot may offer a therapeutic solution, particularly in complex trauma with multiple tendon injury.
Collapse
Affiliation(s)
- Camille Brenac
- Hospices Civils de Lyon, Hôpital Croix Rousse, Service de Chirurgie Plastique, Esthétique et Réparatrice, Lyon F-69003, France.
| | - Martine Pithioux
- Aix Marseille Univ, CNRS, ISM, 13009 Marseille, France; Aix Marseille Univ, APHM, CNRS, ISM, Mecabio Platform, Department of Orthopaedics and Traumatology, 13009 Marseille, France; Aix Marseille Univ, APHM, CNRS, ISM, Sainte-Marguerite Hospital, Institute for Locomotion, Department of Orthopaedics and Traumatology, 13009 Marseille, France
| | - Sacha Tomczak
- Plastic and Reconstructive Surgery Department, Hôpital Conception, AP-HM, Marseille, France
| | - Marylène Lallemand
- Ecole Centrale Marseille, 13013 Marseille, France; Aix Marseille Univ, APHM, CNRS, ISM, Mecabio Platform, Department of Orthopaedics and Traumatology, 13009 Marseille, France
| | - Charlotte Jaloux
- Hand Surgery and Limb Reconstructive Surgery, CHU de Timone, Aix-Marseille University, 264 Rue Saint Pierre, 13005 Marseille, France
| | - Jean Baptiste de Villeneuve Bargemon
- Hand Surgery and Limb Reconstructive Surgery, CHU de Timone, Aix-Marseille University, 264 Rue Saint Pierre, 13005 Marseille, France; Hand, Wrist and Elbow Surgery, Saint Roch Private Hospital, Toulon, 99 Avenue Saint Roch, 83100 Toulon, France
| |
Collapse
|
2
|
Chen J, Yang QQ, Tang JB. Healing strength of tendon repair with or without knots between two tendon ends and histological changes in a chicken model. J Plast Reconstr Aesthet Surg 2023; 87:310-315. [PMID: 37925920 DOI: 10.1016/j.bjps.2023.10.093] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 08/19/2023] [Accepted: 10/07/2023] [Indexed: 11/07/2023]
Abstract
We studied the healing strength and histological changes of digital flexor tendons repaired using Kessler (core suture knots placed over the tendon surface) and modified Kessler (core suture knots placed between two tendon ends) in 31 long toes of chicken. Four weeks after surgery, the healing tendons were measured in a tensile testing machine, and the adhesion formation and histological changes were observed. The strength of the Kessler repairs was significantly greater than that of the modified Kessler repairs with a 35% mean difference. No significant difference was found between the adhesion scores of the tendons repaired with both techniques. In histological sections, the arrangement of collagen fibers in the modified Kessler repair group was more disordered. We conclude that the tendons repaired with the Kessler method are stronger than those with the modified Kessler technique. The knots between tendon ends are detrimental to the early healing strength of digital flexor tendons.
Collapse
Affiliation(s)
- Jing Chen
- The Hand Surgery Research Center, Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Qian Qian Yang
- The Hand Surgery Research Center, Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Jin Bo Tang
- The Hand Surgery Research Center, Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China.
| |
Collapse
|
3
|
Qian Yang Q, Chen J. Moving away from original to modified Kessler tendon repair is likely unwise. J Hand Surg Eur Vol 2022; 47:428-429. [PMID: 35000490 DOI: 10.1177/17531934211070699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Qian Qian Yang
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Jing Chen
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| |
Collapse
|
4
|
Sadek AF. Flexor digitorum profundus with or without flexor digitorum superficialis tendon repair in acute Zone 2B injuries. J Hand Surg Eur Vol 2020; 45:1034-1044. [PMID: 32576070 DOI: 10.1177/1753193420932446] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A total of 53 patients with complete cuts of two flexor tendons in Zone 2B treated over a 9-year period was reviewed. Twenty-three patients (28 fingers) had only flexor digitorum profundus repair, while 30 patients (36 fingers) had both flexor digitorum profundus and flexor digitorum superficialis repairs, with a mean follow-up of 21 months (range 12-84). The decision to repair the flexor digitorum superficialis was made according to intraoperative judgement of ease of repair and gliding of the flexor digitorum profundus tendon. Two groups of patients showed no significant differences in total range of active or passive digital motion and power grip percentage to the contralateral hand. However, the values of power grip were statistically superior in the patients with both tendons repaired. The patients after flexor digitorum profundus-only repairs showed significantly greater but still mild flexion contracture (mean 20 °) of the operated digits. The Tang gradings were the same with 89% good and excellent rates in both groups. The conclusion is that although repair of both flexor digitorum profundus and flexor digitorum superficialis tendons is slightly more preferable based on increased grip strength, the repair of the flexor digitorum superficialis together with flexor digitorum profundus is not mandatory. Whether or not to repair flexor digitorum superficialis is an intraoperative decision based on the ease of gliding of the repaired tendon(s).Level of evidence: III.
Collapse
Affiliation(s)
- Ahmed F Sadek
- Orthopaedic Surgery Department, Minia University Hospital, Minia, Egypt
| |
Collapse
|
5
|
Mao WF, Wu YF. Effects of a Q Suture Technique on Resistance to Gap Formation and Tensile Strength of Repaired Tendons: An Ex Vivo Mechanical Study. J Hand Surg Am 2020; 45:258.e1-258.e7. [PMID: 31451319 DOI: 10.1016/j.jhsa.2019.06.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 04/04/2019] [Accepted: 06/11/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE The repair of digital flexor tendons following laceration should aim to prevent gapping at the repair site and restore the tensile strength of the tendons to facilitate postoperative movement. We present here a simple Q suture and test its effects on gap formation and tensile strength of the repaired tendons. METHODS Sixty porcine tendons were repaired with 3 2-strand sutures (Kessler, Kessler plus 2Q, and Kessler plus running sutures) and 3 4-strand sutures (double Kessler, double Kessler plus 2Q, and double Kessler plus running sutures). The specimens were subjected to a cyclic loading. At each cycle, the number of tendons that initiated gapping or formed a 2-mm gap at the repair site was determined. After the cyclic load testing, the gap distance between tendon ends and the ultimate strength of the repaired tendons was measured. RESULTS In both 2-strand and 4-strand tendon repairs, augmentation by insertion of the 2Q sutures reduced the number of tendons that showed 2-mm gaps ends during loading. Compared with the single Kessler and Kessler plus running sutures, Kessler plus 2Q suture significantly increased the ultimate strength of the tendon repair. Compared with the double Kessler and double Kessler plus running sutures, double Kessler plus 2Q suture significantly decreased the gap distance at the repair site after cyclic loading. CONCLUSIONS The Q suture technique effectively enhances the resistance to gap formation of 2-strand and 4-stand tendon repair. It also improves the tensile strength of 2-strand Kessler repairs. CLINICAL RELEVANCE The Q suture is a simple technique that can resist gap formation and strengthen the tensile strength of the repaired tendons in the laboratory setting.
Collapse
Affiliation(s)
- Wei Feng Mao
- Hand Surgery Research Center, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Ya Fang Wu
- Hand Surgery Research Center, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China.
| |
Collapse
|
6
|
Pan ZJ, Pan L, Xu YF, Ma T, Yao LH. Outcomes of 200 digital flexor tendon repairs using updated protocols and 30 repairs using an old protocol: experience over 7 years. J Hand Surg Eur Vol 2020; 45:56-63. [PMID: 31690153 DOI: 10.1177/1753193419883579] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We reviewed outcomes of 230 flexor tendon repairs in 27 thumbs and 203 fingers in Zone 1 and 2 over 7 years. In 2013, we used a 2-strand modified Kessler method followed by passive motion exercise in repairing flexor digitorum profundus tendon injuries in Zone 2 in 30 fingers; 24 fingers were followed, five (26%) had repair ruptures. Between 2014 and 2017, we used a 4- or 6-strand method to repair 111 flexor digitorum profundus tendons in Zone 2, followed by true early active motion. Two had repair ruptures. Among 101 fingers followed over 6 months, two fingers had tenolysis and 87 (87%) good or excellent outcomes. In 2018 to 2019, we used a 6-strand method to repair 42 flexor digitorum profundus tendons in Zone 2 with out-of-splint early active motion. None had repair ruptures or tenolysis. From 2014 to 2019, 27 flexor pollicis longus tendons were repaired in Zone 1 or 2, and 20 fingers had end-to-end flexor digitorum profundus repairs in Zone 1; none had repair ruptures or tenolysis. We conclude that a strong repair and true active motion are necessary for best outcomes of flexor tendon repairs in the thumb and fingers, and out-of-splint true active motion is safe.
Collapse
Affiliation(s)
- Zhang Jun Pan
- Department of Hand Surgery, Affiliated Yixing Hospital of Jiangsu University, Jiangsu, China
| | - Lei Pan
- Department of Hand Surgery, Affiliated Yixing Hospital of Jiangsu University, Jiangsu, China
| | - Yun Fei Xu
- Department of Hand Surgery, Affiliated Yixing Hospital of Jiangsu University, Jiangsu, China
| | - Tao Ma
- Department of Hand Surgery, Affiliated Yixing Hospital of Jiangsu University, Jiangsu, China
| | - Lei Hui Yao
- Department of Hand Surgery, Affiliated Yixing Hospital of Jiangsu University, Jiangsu, China
| |
Collapse
|
7
|
Karalezli N. Our tenolysis rate after zone 2 flexor tendon repairs and modified Duran passive motion protocol over the past 3 years. J Hand Surg Eur Vol 2019; 44:867-868. [PMID: 31500528 DOI: 10.1177/1753193419846755] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Nazim Karalezli
- Orthopedic Department, Sıtkı Kocman University, Mugla, Turkey.,nkaralezli@yahoo. com
| |
Collapse
|
8
|
Pan ZJ, Pan L, Fei Xu Y. Infrequent need for tenolysis after flexor tendon repair in zone 2 and true active motion: a four-year experience. J Hand Surg Eur Vol 2019; 44:865-866. [PMID: 31500529 DOI: 10.1177/1753193419844157] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Zhang Jun Pan
- Department of Hand Surgery, Yixing People's Hospital, Yixing, Jiangsu, China
| | - Lei Pan
- Department of Hand Surgery, Yixing People's Hospital, Yixing, Jiangsu, China
| | - Yun Fei Xu
- Department of Hand Surgery, Yixing People's Hospital, Yixing, Jiangsu, China
| |
Collapse
|
9
|
|
10
|
Pan ZJ, Xu YF, Pan L, Chen J. Zone 2 flexor tendon repairs using a tensioned strong core suture, sparse peripheral stitches and early active motion: results in 60 fingers. J Hand Surg Eur Vol 2019; 44:361-366. [PMID: 30732521 DOI: 10.1177/1753193419826493] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We report the outcomes of zone 2 tendon repairs in 60 fingers using a strong core suture, sparse peripheral stitches and early active motion. From January 2014 to April 2016, we repaired 60 flexor digitorum profundus tendons with a tensioned 4-strand or 6-strand core suture and three to four peripheral stitches. The A2 or A4 pulleys were vented as necessary. Following early active flexion of the repaired tendons, no repairs ruptured and 52/60 (87%) fingers recovered to good or excellent function using the Tang criteria after follow-up of 8-33 months. We conclude that tensioned multi-strand strong core repairs only require sparse peripheral stitches and are safe for early active flexion. Standard peripheral sutures are not necessary. The core sutures should be properly tensioned to prevent gapping at tendon repair site and pulleys should be sufficiently vented to allow tendon motion. Level of evidence: IV.
Collapse
Affiliation(s)
| | - Yun Fei Xu
- 1 People's Hospital of Yixing, Wuxi, Jiangsu, China
| | - Lei Pan
- 1 People's Hospital of Yixing, Wuxi, Jiangsu, China
| | - Jing Chen
- 2 Jiangsu Medical Research Center, Nantong, and Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| |
Collapse
|
11
|
Yang QQ, Zhou YL. Comparison of the strength of two multi-strand tendon repair configurations in a chicken model. HAND SURGERY & REHABILITATION 2018; 38:67-70. [PMID: 30448036 DOI: 10.1016/j.hansur.2018.10.239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 09/20/2018] [Accepted: 10/08/2018] [Indexed: 11/26/2022]
Abstract
We sought to investigate the strength of two multi-strand tendon repair configurations in a chicken model. Fifty-six chicken flexor tendons were repaired with one to two different four-strand configurations: 1) a four-strand repair consisting of a two-strand core modified Kessler suture with a circle loop repair and 2) a four-strand core Kessler suture repair with three separate peripheral suture points. The strength of the repaired tendons were measured 2, 3 and 4 weeks after the surgical repair and were analyzed statistically. The strength of the two repair methods was not statistically different 2 weeks after surgery. The tendons repaired with the four-strand core Kessler suture repair and three separate peripheral suture points were significantly stronger than those repaired with a two-strand core modified Kessler suture and a circle loop repair at 3 weeks (P = 0.033) and 4 weeks (P = 0.039). The four-strand repair with three separate peripheral suture points had greater strength than a two-strand repair with one circle loop suture based on an in vivo chicken flexor tendon model.
Collapse
Affiliation(s)
- Q Q Yang
- The Hand Surgery Research Center, Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong 226001, PR China
| | - Y L Zhou
- The Hand Surgery Research Center, Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong 226001, PR China.
| |
Collapse
|