Effect of Epitendinous Suture Placement for Flexor Tendon Repair in Combination with Three-Loop Pulley and Locking Loop Suture Patterns in a Canine Cadaveric Model

Introduction: Epitendinous (E) suture patterns in human flexor tendon repairs increase repair strength by 10–50%. Use of E suture patterns for canine tendon repair with commonly utilized patterns has not been described. The objective of this study was to evaluate the effect of simple running E suture pattern with three-loop pulley (3LP) and locking loop (LL) patterns for flexor tendon repair in an ex vivo canine cadaveric model.

Materials and Methods: Superficial digital flexor musculotendinous (SDFT) specimens were randomly divided into 4 groups (n = 18); after sharp transection SDFT were repaired with 3LP, LL, 3LP + E or LL + E. Constructs were placed in a tensile testing machine and tested to failure. Failure mode, gap formation, yield, peak, and failure force were analyzed. Significance was set at p < 0.05.

Results: Mean peak force and force at failure for 3LP and LL was 79.8 N ± 23.0, which was significantly lower compared with repairs where an E pattern was used, 192.1 N ± 57.3 (p < 0.0001). There was complete absence of gapping with the addition of an E pattern. 3-LP was superior to LL when used alone in preventing gap formation (p = 0.001).

Discussion/Conclusion: Addition of an E pattern significantly reduced the occurrence of gapping and increased the force at failure, peak force and yield force of tenorrhaphies. Use of an E suture pattern in a clinical setting should be considered to increase repair site strength and resist gap formation.

Acknowledgment: There was no proprietary interest or funding provided for this project.