Strength of the suture in the epitenon and within the tendon fibres: development of stronger peripheral suture technique.

In tendon repair, the peripheral stitches are usually placed in the epitenon, but it has not yet been defined whether the grasping strength of the sutures in the epitenon and within the tendon fibres are different. The first stage of this work investigated this difference and found that peripheral stitches within cadaveric tendon fibres were 83% stronger than those in the epitenon layer. A new peripheral stitch, based on this finding, has been designed. Mechanical tests of a range of peripheral suture types in vitro found that the new technique gave a resistance to gap formation twice that of the peripheral stitches commonly in use at present and a rupture strength more than three times, while still avoiding eversion problems.