Biomechanical Evaluation of Flexor Tendon Repair: Double Loop Technique with Epitendinous Suture

Sadagatullah AN; Raghu S; Paiman M; Ismail S; Jusoh MH

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Biomechanical Evaluation of Flexor Tendon Repair: Double Loop Technique with Epitendinous Suture

Author: Sadagatullah AN ¹ ; Raghu S ¹ ; Paiman M ¹ ; Ismail S ² ; Jusoh MH ¹
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1. Department of Orthopaedics, Universiti Sains Malaysia, Kubang Kerian, Malaysia
2. Department of Orthopaedics, Universiti Sains Malaysia, Kubang Kerian, Malaysia; Department of Anatomy and Physiology, Universiti Sultan Zainal Abidin, Kuala Terenggganu, Malaysia
Publication Type:Journal Article
Keywords: biomechanics; flexor tendon; monofilament polypropylene suture; repair
From:Malaysian Orthopaedic Journal 2025;19(No. 2):1-8
CountryMalaysia
Language:English
Abstract: Introduction: There are various methods used to repair lacerated tendons. The minimum requirement for the best results and lowest rupture rate is the four-strand repair technique. The cruciate type of repair is among the most popular methods available but is very technical and requires expertise. An easier two-double-loop method for tendon healing is suggested in this study. This study assessed the biomechanical properties of two well-known tendon repair techniques—the modified Kessler and cruciate approaches—and two lesser-known double-loop techniques for tensile strength, stiffness, and failure mode. Materials and methods: Twenty-four adult chickens' Achilles tendons were randomly divided into three groups and sutured with a four-strand core suture using the fourstrand modified Kessler technique, the four-strand cruciate technique, and the two-double-loop approach. Twenty-four more adult chicken Achilles tendons were acquired, and they were randomly assigned to the same three groups along with an extra running epitendinous repair. A synthetic, nonabsorbable monofilament polypropylene suture was used for all repairs. Results: The four-strand modified Kessler, and the fourstrand cruciate procedures had the lowest mean ultimate tensile strength, whereas the two double-loop techniques had the strongest. The results were dramatically impacted by using an epitendinous suture during test analysis. Conclusion: The strongest and comparatively less technically complex technique used in this investigation was the two-double-loop, four-strand core suture method. The significance of the extra strength that the epitendinous suture gave was clear. Using this in a clinical setting is recommended for hand flexor tendon injuries.
Full text:2026030912321485566flexor-tendon-repair.pdf