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The Strength of Epitendinous Tendon Repairs and When a Core Suture is Needed
Elif Ozyurekoglu, Laxminarayan Bhandari, MD
CM Kleinert Institute for Hand and Microsurgery
2019-03-02
Presenter: Laxminarayan Bhandari
Affidavit:
The student completed this research as a science fair project. She contributed overall 75% of the work of the study.
Director Name: Michelle Palazzo
Author Category: Fellow Plastic Surgery
Presentation Category: Basic Science Research
Abstract Category: Hand
Partial tendon lacerations can be treated with core sutures, epitendinous sutures, or no sutures depending on the percentage of laceration. Most surgeons agree that over 60% must be lacerated before a surgical repair is required. A 2-millimeter gap formation in a tendon after a laceration may cause triggering or increase adhesions.
This research tested the strength of flexor-tendon epitendinous repairs to determine the point at which they failed with at-least-2-millimeter gap formation or complete rupture.
Fifty-seven human cadaveric tendons were cut at 30%, 50%, 70% and 90% and were evaluated in three groups: no suture, simple epitendinous, or Silfverskiold epitendinous. 5, 10, 20, 30 and 40 pounds of force were exerted while recording the tendon laceration or suture site with a camera.
The tendons with no suture formed a 2-millimeter gap at a mean of 24.1, 5.2, 2.9 and 0.8 pounds for 30%, 50%, 70% and 90% lacerations respectively. The simple epitendinous group formed the gap with 33.1,11.8, 5.3 and 2.5 pounds. The Silfverskiold group formed the gap with 26.4,17.5, 16.1, and 6.2 pounds. In all groups, ruptures occurred at lacerations 50% and above before 40-pound-load was reached.
The data shows evidence that tendons can form 2-millimeter gaps with lacerations of only 30% with or without a repair; they can rupture with repair at laceration of 50% when loaded up to 40 pounds, suggesting that surgical repairs with epitendinous sutures are needed at 30% and core sutures are needed at 50%.
