In-vitro strength of flexor-tendon repairs

Sanders DW, Bain GI, Johnson JA, Milne AD, Roth JH, King GJ

Department of Surgery, University of Western Ontario, London.

OBJECTIVE: To compare the standard Tajima technique for flexor-tendon repair of the hand with three new techniques with respect to strength and technical ease of the repair and bulk at the repair site.

DESIGN: A randomized analysis of human cadaver flexor digitorum superficialis tendon repairs.

SETTING: A musculoskeletal research laboratory at a university-affiliated health centre.

MATERIAL: Thirty-nine fresh-frozen cadaveric flexor digitorum superficialis tendons from index, long and ring fingers harvested and divided transversely. The tendons were randomly allocated for repair by the current standard technique or one of three new techniques.

INTERVENTIONS: The standard Tajima (modified Kessler) technique, and the Halsted, Savage or Silfverskiold technique.

MAIN OUTCOME MEASURES: The time to perform each repair, the cross-sectional dimension and the load to failure of the tendon repairs.

RESULTS: The Savage repair tolerated the highest loads, followed by the Halsted, Silfverskiold and Tajima repairs. The Silfverskiold technique was the least time-consuming to perform, followed by the Tajima, Halsted and Savage repairs. All of the techniques increased the cross-sectional dimensions of the tendon: the Silfverskiold repair by at least 50% and the Savage repair by over 100%. Although none of the techniques tested performed ideally, all three new techniques provided greater initial static strength than the standard Tajima method.

CONCLUSION: Further in-vitro and in-vivo studies of these new techniques of flexor-tendon repair of the hand are necessary to optimize the treatment of these injuries.

Can J Surg 1995 Dec;38(6):528-32