Gliding resistance after repair of partially lacerated human flexor digitorum profundus tendon in vitro

Objective. This study reports the gliding resistance between repaired, partially lacerated tendon and pulley in human cadaver digits, using several commonly employed repair techniques. Background. Suture techniques with multi-strands and locking loops have been recommended to reduce the risk of rupture of the repair tendon with early active motion. Such sutures may increase the gliding resistance, and the gliding resistance after tendon repair is also an important factor influencing the rehabilitation. Method. 105 specimens of second, third, or fourth fingers from 36 adult human hands were tested for the gliding resistance between flexor digitorum profundus tendon and A2 pulley in the normal condition. After an 80% laceration, each tendon was repaired with one of the following suture techniques: (1) Kessler; (2) modified Kessler; (3) Savage; (4) Lee; (5) Tsuge; and (6) Becker. All suture techniques were reinforced with a circumferential epitenon simple running suture. After tendon repair, the gliding resistance was remeasured. Results. The gliding resistance of the Becker repair was significantly greater than each of the other four repairs (P<0.05). The resistance of the modified Kessler repair was significantly less than that of the Kessler, Savage, or Tsuge repairs. Conclusions. We conclude that the type of tendon repair can significantly affect the gliding resistance between the tendon and pulley system after tendon repair. Relevance. The design of the tendon repair, through its effect on friction, may have an adverse effect on the clinical results of tendon mobilization.