Biomechanical Analysis of Tendon Suture Tecniques

Kwang Suk Lee; Jae Young Jeon; Kyung Jo Woo; Cheol Hyo Bae

doi:10.4055/jkoa.1996.31.2.255

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Lee, Jeon, Woo, and Bae: Biomechanical Analysis of Tendon Suture Tecniques

Original Article

J Korean Orthop Assoc 1996;31(2):255-264.

Published online: 1 April 1996

DOI: https://doi.org/10.4055/jkoa.1996.31.2.255

Biomechanical Analysis of Tendon Suture Tecniques

Kwang Suk Lee, M.D., Jae Young Jeon, M.D., Kyung Jo Woo, M.D., Cheol Hyo Bae, M.D.

Department of Orthopaedic Surgery, Korea University Hospital, Seoul, Korea

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Successful repair of lacerated tendons must restore continuity of the tendon and should yield a strong tenorrhaphy. Mechanical strength of repair should be adequate to early postoperative motion and mobility. The optimal repair technique must be able to withstand the rigors of early motion and also must not interfere with tendon healing.

The relative strength of three suture methods of lacerated tendon were measured by mechanical disruption in effort to determine the strength of suture technique.

Fifty-four calcaneal tendons of 27 the New Zealand white rabbit were transected at mid portion and repaired with the three suture techniques: group 1, Kessler suture, group 2, Pennington’s modified-Kessler suture and group 3, augmented-Becker suture technique. Each group was composed of 18 calcaneal tendons. Nine rabbits were sacrified immediately after suture, nine in postoperative 2 weeks and nine in postoperative 4 weeks.

Six calcaneal tendons in each three experimental group were obtained immediately after suture, at postoperative 2 and 4 weeks respectively.

Tensile strength, maximum strength and modulus of elasticity of all experimental specimens were measured with Instron-UTM-4-100(Tyo-Baldiwin, Japan).

The results were evaluated statistically to compare the strengh of the three suture technique at three different periods. The tensile strength was predominantly strongest in augmented-Becker method among three suture technique at immediate suture, postoperative 2 weeks and 4 weeks respectively. The augmented Becker repair was strongest in maximum stress among Kessler and modified Kessler repair at immediate operation, postoperative 2 weeks and 4 weeks respectively.

The augmented Becker repair was highest in modulus of elasticity than Kessler method and modified-Kessler method at immediate operation, postoperative 2 weeks and postoperative 4 weeks respectively. Tensile strength, maximum stress and modulus of elasticity were gradully increased from immediate operation to postoperative 4 weeks, but there were not statistically significance between experimental three suture methods at postoperative 4 weeks.

Keywords: Tendon, Suture, Biomechanical strength

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Fig. 1

Schematic drawing of tendon repair technique. A. Kessler technique with 4-0 nylon, B. Pennington’s modified Kessler technique with core stitch of 4-0 nylon and epitenon - first suture with 5-0 vicryl. C. Augmented - Becker repair with two rows of criss-crossing 4-0 nylon and epitenon - first suture with 5-0 vicryl.

Fig. 2

Instron Model UTM-4-100 (Toyo-Baldiwin, Japan)

Fig. 3

Schematic drawing of ten don clip in 15 mm width.

Fig. 4

Mean value of maximum load according to three suture methods.

Fig. 5

Mean value of maximum strength according to three methods.

Fig. 6

Mean value of modulus of clasticity according to three suture methods.

Table 1

Suture method, suture material and model setting of Instron Model -UTM-4-100(Toto-Baldiwin, Japan)

suture method	Group I Kessler method	Group II modified-Kessler	Group III augmented-Becker
suture material
core suture	#4-0 nylon	#4-0 nylon	#4-0 nylon
epitenon suture	-	#5-0 vicryl	#5-0 vicryl
skin suture	#3-0 silk	#3-0 silk	#3-0 silk
Model setting
Instron	channel speed	channel speed	channel speed
-UTM-4-100	:20mm/min	:20mm/min:	:20mm/min
	gauge length	gauge length	gauge length
	:15mm	:15mm	:15mm
	load cell	load cell	load cell
	:5kg	:5kg	:5kg

Table 2

Biomechanical properties of tendon repair with Kessler method.

	Immediate OP Mean SD	2 weeks Mean SD	4 weeks Mean SD
Maximal load
Kg	1.16±0.19	3.87 ± 1.88	6.35 ± 0.46
kg/mm2	0.90±0.15	3.02 ± 0.70	4.96 ± 0.35
Maximal strength
MPA	8.85 ±1.45	29.65 ± 6.85	48.67 ± 3.52
Modulus of elasticity
kg/mm2	0.98 ±0.05	6.41 ± 3.36	16.34± 6.99
MPA	9.57 ±0.50	62.85 ± 33.04	160.29 ± 68.64

* SD;standard deviation

Table 3

Biomechanical properties of tendon repair with modified-Kessler method.

	Immediate OP Mean SD	2 weeks Mean SD	4 weeks Mean SD
Maximal load
kg	2.33 ± 0.80	4.75 ± 1.46	6.50 ± 0.18
kg/mm2	1.83 ± 0.62	3.71 ± 0.69	5.09 ± 0.15
Maximal strength
MPA	18.85 ± 6.22	36.38 ± 6.85	49.87 ± 2.48
Modulus of elasticity
kg/mm2	4.46 ± 1.99	9.53 ± 3.90	19.23 ± 7.22
MPA	43.40 ± 19.54	93.48 ±37.82	188.75 ± 70.76

* SD;standard deviation

Table 4

Biomechanical properties of tendon repair with augmented-Becker method.

	Immediate OP Mean SD	2 weeks Mean SD	4 weeks Mean SD
Maximal load
kg	3.27 ± 0.24	5.70 ± 1.14	6. 58 ± 0.33
kg/mm2	2.56 ± 0.19	4.45 ± 0.89	5.144 ± 0.260
Maximal strength
MPA	25.08 ± 1.89	43.64 ± 8.75	50. 45 ± 2.59
Modulus of elasticity
kg/mm2	5.76± 1.47	13.63 ± 6.12	19. 20 ± 5.68
MPA	56.48 ±14.46	133.70 ± 60.02	188. 31 ± 55.76

* SD;standard deviation

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