The effect of increased peripheral suture purchase on the strength of flexor tendon repairs

Gregory A. Merrell, Scott W. Wolfe, William J. Kacena, Yutong Gao, Jacek Cholewicki, Melissa Kacena

Research output: Contribution to journalArticle

43 Citations (Scopus)

Abstract

Purpose: Previous studies have hypothesized unequal load sharing between peripheral and core sutures in flexor tendon repairs. Most commonly peripheral sutures are placed very near the repair site and characteristically fail before the core strands. We hypothesized that placement of the peripheral sutures farther from the repair site would better optimize load sharing and resist suture pullout, yielding a stronger overall repair. Methods: To test the hypothesis we developed a mathematical model of the load sharing between core and peripheral sutures. By using this model we predicted that placement of peripheral sutures 2 mm from the repair site would optimize the balance of load between core and peripheral sutures. We then divided and repaired 27 flexor digitorum profundus tendons in 6 ways (core plus peripheral or peripheral sutures only at 1 mm, 2 mm, or 3 mm from the repair site). Tendons were clamped to a custom-built linear loading machine and distracted to failure. Results: There was a clinically and statistically significant increase in strength with an increased distance of the peripheral suture from the repair site showing that core sutures augmented by a 2-mm peripheral repair were stronger than those performed with 1-mm peripheral repairs (50.8 vs 37.1 N). Conclusions: A peripheral stitch placement approximately 2 mm from the repair site represents a simple modification that can significantly increase the ultimate strength of flexor tendon repairs.

Original languageEnglish (US)
Pages (from-to)464-468
Number of pages5
JournalJournal of Hand Surgery
Volume28
Issue number3
DOIs
StatePublished - May 2003
Externally publishedYes

Fingerprint

Tendons
Sutures
Theoretical Models

Keywords

  • Flexor tendon
  • Mathematical model
  • Mechanics
  • Peripheral suture
  • Tendon repair

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Surgery

Cite this

The effect of increased peripheral suture purchase on the strength of flexor tendon repairs. / Merrell, Gregory A.; Wolfe, Scott W.; Kacena, William J.; Gao, Yutong; Cholewicki, Jacek; Kacena, Melissa.

In: Journal of Hand Surgery, Vol. 28, No. 3, 05.2003, p. 464-468.

Research output: Contribution to journalArticle

Merrell, Gregory A. ; Wolfe, Scott W. ; Kacena, William J. ; Gao, Yutong ; Cholewicki, Jacek ; Kacena, Melissa. / The effect of increased peripheral suture purchase on the strength of flexor tendon repairs. In: Journal of Hand Surgery. 2003 ; Vol. 28, No. 3. pp. 464-468.
@article{fe5dc8e226314498b4355eded0764db3,
title = "The effect of increased peripheral suture purchase on the strength of flexor tendon repairs",
abstract = "Purpose: Previous studies have hypothesized unequal load sharing between peripheral and core sutures in flexor tendon repairs. Most commonly peripheral sutures are placed very near the repair site and characteristically fail before the core strands. We hypothesized that placement of the peripheral sutures farther from the repair site would better optimize load sharing and resist suture pullout, yielding a stronger overall repair. Methods: To test the hypothesis we developed a mathematical model of the load sharing between core and peripheral sutures. By using this model we predicted that placement of peripheral sutures 2 mm from the repair site would optimize the balance of load between core and peripheral sutures. We then divided and repaired 27 flexor digitorum profundus tendons in 6 ways (core plus peripheral or peripheral sutures only at 1 mm, 2 mm, or 3 mm from the repair site). Tendons were clamped to a custom-built linear loading machine and distracted to failure. Results: There was a clinically and statistically significant increase in strength with an increased distance of the peripheral suture from the repair site showing that core sutures augmented by a 2-mm peripheral repair were stronger than those performed with 1-mm peripheral repairs (50.8 vs 37.1 N). Conclusions: A peripheral stitch placement approximately 2 mm from the repair site represents a simple modification that can significantly increase the ultimate strength of flexor tendon repairs.",
keywords = "Flexor tendon, Mathematical model, Mechanics, Peripheral suture, Tendon repair",
author = "Merrell, {Gregory A.} and Wolfe, {Scott W.} and Kacena, {William J.} and Yutong Gao and Jacek Cholewicki and Melissa Kacena",
year = "2003",
month = "5",
doi = "10.1053/jhsu.2003.50074",
language = "English (US)",
volume = "28",
pages = "464--468",
journal = "Journal of Hand Surgery",
issn = "0363-5023",
publisher = "W.B. Saunders Ltd",
number = "3",

}

TY - JOUR

T1 - The effect of increased peripheral suture purchase on the strength of flexor tendon repairs

AU - Merrell, Gregory A.

AU - Wolfe, Scott W.

AU - Kacena, William J.

AU - Gao, Yutong

AU - Cholewicki, Jacek

AU - Kacena, Melissa

PY - 2003/5

Y1 - 2003/5

N2 - Purpose: Previous studies have hypothesized unequal load sharing between peripheral and core sutures in flexor tendon repairs. Most commonly peripheral sutures are placed very near the repair site and characteristically fail before the core strands. We hypothesized that placement of the peripheral sutures farther from the repair site would better optimize load sharing and resist suture pullout, yielding a stronger overall repair. Methods: To test the hypothesis we developed a mathematical model of the load sharing between core and peripheral sutures. By using this model we predicted that placement of peripheral sutures 2 mm from the repair site would optimize the balance of load between core and peripheral sutures. We then divided and repaired 27 flexor digitorum profundus tendons in 6 ways (core plus peripheral or peripheral sutures only at 1 mm, 2 mm, or 3 mm from the repair site). Tendons were clamped to a custom-built linear loading machine and distracted to failure. Results: There was a clinically and statistically significant increase in strength with an increased distance of the peripheral suture from the repair site showing that core sutures augmented by a 2-mm peripheral repair were stronger than those performed with 1-mm peripheral repairs (50.8 vs 37.1 N). Conclusions: A peripheral stitch placement approximately 2 mm from the repair site represents a simple modification that can significantly increase the ultimate strength of flexor tendon repairs.

AB - Purpose: Previous studies have hypothesized unequal load sharing between peripheral and core sutures in flexor tendon repairs. Most commonly peripheral sutures are placed very near the repair site and characteristically fail before the core strands. We hypothesized that placement of the peripheral sutures farther from the repair site would better optimize load sharing and resist suture pullout, yielding a stronger overall repair. Methods: To test the hypothesis we developed a mathematical model of the load sharing between core and peripheral sutures. By using this model we predicted that placement of peripheral sutures 2 mm from the repair site would optimize the balance of load between core and peripheral sutures. We then divided and repaired 27 flexor digitorum profundus tendons in 6 ways (core plus peripheral or peripheral sutures only at 1 mm, 2 mm, or 3 mm from the repair site). Tendons were clamped to a custom-built linear loading machine and distracted to failure. Results: There was a clinically and statistically significant increase in strength with an increased distance of the peripheral suture from the repair site showing that core sutures augmented by a 2-mm peripheral repair were stronger than those performed with 1-mm peripheral repairs (50.8 vs 37.1 N). Conclusions: A peripheral stitch placement approximately 2 mm from the repair site represents a simple modification that can significantly increase the ultimate strength of flexor tendon repairs.

KW - Flexor tendon

KW - Mathematical model

KW - Mechanics

KW - Peripheral suture

KW - Tendon repair

UR - http://www.scopus.com/inward/record.url?scp=0037515321&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0037515321&partnerID=8YFLogxK

U2 - 10.1053/jhsu.2003.50074

DO - 10.1053/jhsu.2003.50074

M3 - Article

VL - 28

SP - 464

EP - 468

JO - Journal of Hand Surgery

JF - Journal of Hand Surgery

SN - 0363-5023

IS - 3

ER -