Biomechanical Analysis of Flexor Tendon Repair Using Knotted Kessler and Bunnell Techniques and the Knotless Bunnell Technique

• Published in: The Journal of hand surgery (American ed.) Vol. 40; no. 1; pp. 115 - 120
• Main Authors: Jordan, Martin C., MD, Schmidt, Karsten, MD, Meffert, Rainer H., MD, Hoelscher-Doht, Stefanie, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 2015
• Subjects: 4-strand Bunnell; Animals; Barbed suture; Biomechanical Phenomena; Bunnell suture; double Bunnell; flexor tendon repair; Models, Animal; Orthopedics; Suture Techniques; Swine; Tendon Injuries - surgery; Tendons - surgery; Tensile Strength; flexor tendon repair; Bunnell suture; 4-strand Bunnell; Barbed suture; double Bunnell
• ISSN: 0363-5023; 1531-6564
• DOI: 10.1016/j.jhsa.2014.09.015

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.