Comparison of 1- and 2-Knot, 4-Strand, Double-Modified Kessler Tendon Repairs in a Porcine Model

• Published in: The Journal of hand surgery (American ed.) Vol. 34; no. 4; pp. 705 - 709
• Main Authors: Rees, Leila, BM BCh, Matthews, April, MB ChB, Masouros, Spyridon D., PhD, Bull, Anthony M.J., PhD, Haywood, Richard, MBBS
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-04-2009; Elsevier
• Subjects: Animals; Biological and medical sciences; Biomechanical Phenomena; Cyclic loading; Diseases of the osteoarticular system; flexor tendon; four-strand; Medical sciences; Orthopedics; Postoperative Complications - physiopathology; Rupture; Suture Techniques; Swine; Tendon Injuries - surgery; tendon repair; Tenodesis - methods; Tensile Strength - physiology; tensile testing; Weight-Bearing - physiology; Cyclic loading; tensile testing; four-strand; tendon repair; flexor tendon; Node; Pig; Vertebrata; Mammalia; Orthopedics; Flexor muscle; Models; Artiodactyla; Repair; Ungulata; Comparative study; Tendon
• ISSN: 0363-5023; 1531-6564
• DOI: 10.1016/j.jhsa.2008.12.014

Purpose To compare 1- and 2-knot, 4-strand, double-modified Kessler tendon repairs. It was our hypothesis that a 1-knot technique using an unbraided suture material would be stronger if it is possible for some movement to occur between strands on loading, redistributing forces such that the load is equally shared. Methods Fifty-six porcine flexor tendons were allocated to either a 1- or 2-knot, 4-strand, double-modified Kessler repair, and tested by incremental cyclical loading in vitro. Results The 1-knot technique was significantly stronger. Gap formation was initially greater in the 1-knot group, consistent with movement of strands, but with increasing physiological levels of applied force, there was no significant difference between the groups. Conclusions The 1-knot technique was significantly stronger than the 2-knot technique.