Martin C Jordan1, Karsten Schmidt1, Rainer H Meffert1, Stefanie Hoelscher-Doht2. 1. Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital, Würzburg, Germany. 2. Department of Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital, Würzburg, Germany. Electronic address: Hoelscher_S@ukw.de.
Abstract
PURPOSE: To evaluate a knotless Bunnell suture in flexor tendon repair. METHODS: Eighty porcine flexor digitorum tendons were assigned to 4 different suture techniques. Group 1 was repaired using a modified 4-strand knotted Kessler suture and served as a control group. Group 2 was repaired using a 4-strand knotted Bunnell suture. Group 3 used a 4-strand knotless Bunnell suture. Group 4 used a 4-strand knotless Bunnell and knotless peripheral suture. Under static and cyclic testing we studied mode of failure, 2-mm gap formation force, displacement, and maximum load. RESULTS: The 4-strand knotless Bunnell suture did not show a notable difference with regard to 2-mm gap formation force, displacement, or maximum load in comparison to the modified 4-strand knotted Kessler suture. Adding a knotless peripheral suture improved the repair by a significant reduction of gap formation and displacement and an increase in maximum load. The 4-strand knotted Bunnell showed the highest maximum load but also a considerable lower resistance to gap formation and major displacement. CONCLUSIONS: Flexor tendon repair using a 4-strand knotless Bunnell suture showed similar tensile strength to a modified 4-strand knotted Kessler suture. Adding a knotless peripheral suture further improved the repair. CLINICAL RELEVANCE: A complete knotless 4-strand Bunnell suture including a barbed core- and peripheral suture might be an option for flexor tendon reconstruction.
PURPOSE: To evaluate a knotless Bunnell suture in flexor tendon repair. METHODS: Eighty porcine flexor digitorum tendons were assigned to 4 different suture techniques. Group 1 was repaired using a modified 4-strand knotted Kessler suture and served as a control group. Group 2 was repaired using a 4-strand knotted Bunnell suture. Group 3 used a 4-strand knotless Bunnell suture. Group 4 used a 4-strand knotless Bunnell and knotless peripheral suture. Under static and cyclic testing we studied mode of failure, 2-mm gap formation force, displacement, and maximum load. RESULTS: The 4-strand knotless Bunnell suture did not show a notable difference with regard to 2-mm gap formation force, displacement, or maximum load in comparison to the modified 4-strand knotted Kessler suture. Adding a knotless peripheral suture improved the repair by a significant reduction of gap formation and displacement and an increase in maximum load. The 4-strand knotted Bunnell showed the highest maximum load but also a considerable lower resistance to gap formation and major displacement. CONCLUSIONS: Flexor tendon repair using a 4-strand knotless Bunnell suture showed similar tensile strength to a modified 4-strand knotted Kessler suture. Adding a knotless peripheral suture further improved the repair. CLINICAL RELEVANCE: A complete knotless 4-strand Bunnell suture including a barbed core- and peripheral suture might be an option for flexor tendon reconstruction.
Authors: Aakash Chauhan; Patrick Schimoler; Mark C Miller; Alexander Kharlamov; Gregory A Merrell; Bradley A Palmer Journal: Hand (N Y) Date: 2017-04-19