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Review
. 2013 Aug 11;3(3):220-8.

Suture techniques for tendon repair; a comparative review

Shelley Rawson  1 , Sarah Cartmell  1 , Jason Wong  2
Affiliations
Review

Suture techniques for tendon repair; a comparative review

Shelley Rawson et al. Muscles Ligaments Tendons J. .

Abstract

Over the past five decades we have seen numerous iterations of suture repair methods for tendon. The pursuit of the ultimate repair has led to many repair methods being described. This comprehensive compilation of the suture repair techniques will describe the factors that affect repair success, including repair strength, gapping resistance, glide and rehabilitation. Different approaches to rejoining severed tendons will be critiqued on their biomechanical ability to improve tendon repair strength, maintaining glide, reducing tendon damage, and minimising adhesion formation. It is important to highlight how the suture repairs have evolved and improved but also review how they may contribute to their own trauma. The apparent paradox between providing mechanical strength and minimising adhesions require refinements in the field to improve on functional outcomes.

Keywords: adhesion; glide; repair; strength; suture; tendon.

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Figures

Figure 1.
Figure 1.
Some of the joining techniques described in literature. Light Grey = Tendon. White = Suture internal of tendon. Black = suture external of tendon. Dark Grey = Suture external of tendon, dorsally placed (Only shown on figures f and k). * = placement of knot (only shown on figures b, c and m to r). Double strand suture used in repairs m to r. Adapted from, –. a. Bunnell; 2 strand, non-grasping anchor. b. Grasping Kessler; 2 strands, grasping anchor. c. Tajima; 2 strands, grasping anchor. d. Modified locking Kessler (aka. Pennington); 2 strand, locking anchor. e. Four strand double modified Kessler; 4 strands, locking anchor. f. Modified Pennington; 2 strand, locking anchor. g. Becker; Interrupted stitch joining oblique tendon ends. h. Grasping Cruciate; 4 strand, grasping anchor. i. Locking Cruciate; 4 strand, locking anchor. j. Savage; 6 strand, x-stitch anchor. k. Locking Lee; 2 strand, locking anchor with large purchase. l. Tsuge; 2 strand, anchor buried within tendon. m. Four strand Kessler repair. n. Four strand Kessler repair with knots on opposing sides. o. Four strand cross-lock repair. p. Tang. q. U-shaped four strand repair r. Six strand M-tang.
Figure 2.
Figure 2.
General relationship between different suturing techniques and strength, gapping resistance, complexity, handling and gliding resistance.
Figure 3.
Figure 3.
Four different suture anchoring methods. The portion of tendon fibres that the suture anchors around is shown in dark grey. The tendon outline is shown as a dashed in the cross sectional views. Dark grey represents suture which passes outside the tendon on the dorsal side. a. Non-grasping b. Grasping. c. Locking (aka. Pennington Lock) d. Modified Pennington Lock
Figure 4.
Figure 4.
A single suture in an immobilized mouse digital flexor tendon, showing the resultant adhesion. Scale bar 200 microns.
See this image and copyright information in PMC

References

    1. Clayton RA, Court-Brown CM. The epidemiology of musculoskeletal tendinous and ligamentous injuries. Injury. 2008;39(12):1338–1344. - PubMed
    1. Su BW, Solomons M, Barrow A, Senoge ME, Gilberti M, Lubbers L, et al. Device for zone-II flexor tendon repair. A multicenter, randomized, blinded, clinical trial. J Bone Joint Surg Am. 2005;87(5):923–935. - PubMed
    1. Bunnell S. Repair of tendons in the fingers and description of two new instruments. Gynecology and Obstetrics. 1918;26:103–110.
    1. Verdan C. Primary repair of flexor tendons. J Bone Joint Surg Am. 1960;(42-A):647–657. - PubMed
    1. Kleinert H, Spokevicius S, Papas N. History of flexor tendon repair. Journal of Hand Surgery-American Volume. 1995;20A(3):S46–S52. - PubMed

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