1.Biomechanical Evaluation of Flexor Tendon Repair: Double Loop Technique with Epitendinous Suture
Sadagatullah AN ; Raghu S ; Paiman M ; Ismail S ; Jusoh MH
Malaysian Orthopaedic Journal 2025;19(No. 2):1-8
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.


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