Biomechanical Evaluation of Flexor Tendon Repair: Double Loop Technique with Epitendinous Suture
Introduction: There are various methods used to repair lacerated tendons. The minimum requirement for the best results and lowest rupture rate is the four-strand repair technique. The cruciate type of repair is among the most popular methods available but is very technical and requires expertise. An...
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Malaysian Orthopaedic Association
2025-07-01
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| Series: | Malaysian Orthopaedic Journal |
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| Online Access: | https://www.morthoj.org/2025/v19n2/flexor-tendon-repair.pdf |
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| author | Sadagatullah AN Raghu S Paiman M Ismail S Jusoh MH |
| author_facet | Sadagatullah AN Raghu S Paiman M Ismail S Jusoh MH |
| author_sort | Sadagatullah AN |
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| description | Introduction: There are various methods used to repair lacerated tendons. The minimum requirement for the best results and lowest rupture rate is the four-strand repair technique. The cruciate type of repair is among the most popular methods available but is very technical and requires expertise. An easier two-double-loop method for tendon healing is suggested in this study. This study assessed the biomechanical properties of two well-known tendon repair techniques—the modified Kessler and cruciate approaches—and two lesser-known double-loop techniques for tensile strength, stiffness, and failure mode.
Materials and methods: Twenty-four adult chickens' Achilles tendons were randomly divided into three groups and sutured with a four-strand core suture using the four-strand modified Kessler technique, the four-strand cruciate technique, and the two-double-loop approach. Twenty-four more adult chicken Achilles tendons were acquired, and they were randomly assigned to the same three groups along with an extra running epitendinous repair. A synthetic, non-absorbable monofilament polypropylene suture was used for all repairs.
Results: The four-strand modified Kessler, and the four-strand cruciate procedures had the lowest mean ultimate tensile strength, whereas the two double-loop techniques had the strongest. The results were dramatically impacted by using an epitendinous suture during test analysis.
Conclusion: The strongest and comparatively less technically complex technique used in this investigation was the two-double-loop, four-strand core suture method. The significance of the extra strength that the epitendinous suture gave was clear. Using this in a clinical setting is recommended for hand flexor tendon injuries. |
| format | Article |
| id | doaj-art-e676abc3f639413fba033b9276b4be05 |
| institution | Kabale University |
| issn | 1985-2533 2232-111X |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Malaysian Orthopaedic Association |
| record_format | Article |
| series | Malaysian Orthopaedic Journal |
| spelling | doaj-art-e676abc3f639413fba033b9276b4be052025-08-20T03:59:30ZengMalaysian Orthopaedic AssociationMalaysian Orthopaedic Journal1985-25332232-111X2025-07-011921810.5704/MOJ.2507.001Biomechanical Evaluation of Flexor Tendon Repair: Double Loop Technique with Epitendinous SutureSadagatullah AN0 Raghu S1Paiman M2Ismail S3 Jusoh MH4Department of Orthopaedics, Universiti Sains Malaysia, Kubang Kerian, MalaysiaDepartment of Orthopaedics, Universiti Sains Malaysia, Kubang Kerian, MalaysiaDepartment of Orthopaedics, Universiti Sains Malaysia, Kubang Kerian, MalaysiaDepartment of Orthopaedics, Universiti Sains Malaysia, Kubang Kerian, Malaysia; Department of Anatomy and Physiology, Universiti Sultan Zainal Abidin, Kuala Terenggganu, MalaysiaDepartment of Orthopaedics, Universiti Sains Malaysia, Kubang Kerian, MalaysiaIntroduction: There are various methods used to repair lacerated tendons. The minimum requirement for the best results and lowest rupture rate is the four-strand repair technique. The cruciate type of repair is among the most popular methods available but is very technical and requires expertise. An easier two-double-loop method for tendon healing is suggested in this study. This study assessed the biomechanical properties of two well-known tendon repair techniques—the modified Kessler and cruciate approaches—and two lesser-known double-loop techniques for tensile strength, stiffness, and failure mode. Materials and methods: Twenty-four adult chickens' Achilles tendons were randomly divided into three groups and sutured with a four-strand core suture using the four-strand modified Kessler technique, the four-strand cruciate technique, and the two-double-loop approach. Twenty-four more adult chicken Achilles tendons were acquired, and they were randomly assigned to the same three groups along with an extra running epitendinous repair. A synthetic, non-absorbable monofilament polypropylene suture was used for all repairs. Results: The four-strand modified Kessler, and the four-strand cruciate procedures had the lowest mean ultimate tensile strength, whereas the two double-loop techniques had the strongest. The results were dramatically impacted by using an epitendinous suture during test analysis. Conclusion: The strongest and comparatively less technically complex technique used in this investigation was the two-double-loop, four-strand core suture method. The significance of the extra strength that the epitendinous suture gave was clear. Using this in a clinical setting is recommended for hand flexor tendon injuries.https://www.morthoj.org/2025/v19n2/flexor-tendon-repair.pdfbiomechanicsflexor tendonmonofilament polypropylene suturerepair |
| spellingShingle | Sadagatullah AN Raghu S Paiman M Ismail S Jusoh MH Biomechanical Evaluation of Flexor Tendon Repair: Double Loop Technique with Epitendinous Suture Malaysian Orthopaedic Journal biomechanics flexor tendon monofilament polypropylene suture repair |
| title | Biomechanical Evaluation of Flexor Tendon Repair: Double Loop Technique with Epitendinous Suture |
| title_full | Biomechanical Evaluation of Flexor Tendon Repair: Double Loop Technique with Epitendinous Suture |
| title_fullStr | Biomechanical Evaluation of Flexor Tendon Repair: Double Loop Technique with Epitendinous Suture |
| title_full_unstemmed | Biomechanical Evaluation of Flexor Tendon Repair: Double Loop Technique with Epitendinous Suture |
| title_short | Biomechanical Evaluation of Flexor Tendon Repair: Double Loop Technique with Epitendinous Suture |
| title_sort | biomechanical evaluation of flexor tendon repair double loop technique with epitendinous suture |
| topic | biomechanics flexor tendon monofilament polypropylene suture repair |
| url | https://www.morthoj.org/2025/v19n2/flexor-tendon-repair.pdf |
| work_keys_str_mv | AT sadagatullahan biomechanicalevaluationofflexortendonrepairdoublelooptechniquewithepitendinoussuture AT raghus biomechanicalevaluationofflexortendonrepairdoublelooptechniquewithepitendinoussuture AT paimanm biomechanicalevaluationofflexortendonrepairdoublelooptechniquewithepitendinoussuture AT ismails biomechanicalevaluationofflexortendonrepairdoublelooptechniquewithepitendinoussuture AT jusohmh biomechanicalevaluationofflexortendonrepairdoublelooptechniquewithepitendinoussuture |