Abstract
Background
We investigated the factors that influence tensile strength and resistance to gap formation at the repair site of tendon suture (stiffness) by comparing (1) the location of the locking loops and (2) the location of the knot.
Methods
Transected bovine tendons of the medial gastrocnemius (9-11 × 14-16 mm diameter) were sutured with a modified locking Kessler method with a USP (United States Pharmacopeial convention) 2 polyester multifilament suture (0.500-0.599 mm) and loaded to failure using an Instron 5565 tensiometer. The locking loops were located on either the upper surface facing the operator or on side portions of the tendon. The knot was positioned either close to or far from the tendon stump.
Results
The locations of the locking loops did not influence the tensile strength; however, the stiffness of the side loop suture (5.70 ± 0.09 N/mm) was significantly higher than that of the upper surface loop suture (5.17 ± 0.10 N/mm). Regarding the knot location, the tensile strength with the knot far from the tendon stump (195.1 ± 4.8 N) was significantly higher than that with the knot close to the tendon stump (169.0 ± 3.6 N), although the stiffness was unchanged by differences in knot location.
Conclusions
These data suggested that a greater tensile strength with less of a gap is obtained by (1) forming locking loops in the side portion of the tendon, and (2) forming knots far from the tendon stump.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
M Aoki N Ogiwara T Ohta Y Nabeta (1998) ArticleTitleEarly active motion and weightbearing after cross-stitch Achilles tendon repair Am J Sport Med 26 794–800 Occurrence Handle1:STN:280:DyaK1M%2FmslOltQ%3D%3D
RH Gelberman D Amiel M Gonsalves S Woo WH Akeson (1981) ArticleTitleThe influence of protected passive mobilization on the healing of flexor tendons: a biochemical and microangiographic study Hand 13 120–8 Occurrence Handle10.1016/S0072-968X(81)80051-4 Occurrence Handle1:STN:280:DyaL38%2FivVyksg%3D%3D Occurrence Handle7286796
RH Gelberman PR Manske WH Akeson S Woo G Lundborg D Amiel (1986) ArticleTitleFlexor tendon repair J Orthop Res 4 119–28 10.1002/jor.1100040116 Occurrence Handle10.1002/jor.1100040116 Occurrence Handle1:STN:280:DyaL287ktlWktw%3D%3D Occurrence Handle3950804
H Hatanaka T Kojima T Mizoguchi Y Ueshin (2002) ArticleTitleAggressive active mobilization following zone II flexor tendon repair using a two-strand heavy-gauge locking loop technique J Orthop Sci 7 457–61 10.1007/s007760200079 Occurrence Handle10.1007/s007760200079 Occurrence Handle12181659
A Wada H Kubota K Miyanishi H Hatanaka H Miura Y Iwamoto (2001) ArticleTitleComparison of postoperative early active mobilization and immobilization in vivo utilizing a four-strand flexor tendon repair J Hand Surg [Br] 26 301–6 10.1054/jhsb.2000.0547 Occurrence Handle1:STN:280:DC%2BD38%2Fis1Kksg%3D%3D
H Hatanaka J Zhang PR Manske (2000) ArticleTitleAn in vivo study of locking and grasping techniques using a passive mobilization protocol in experimental animals J Hand Surg [Am] 25 260–9 10.1053/jhsu.2000.jhsu25a0260 Occurrence Handle10.1053/jhsu.2000.jhsu25a0260 Occurrence Handle1:STN:280:DC%2BD3c7ovF2iug%3D%3D
S Hotokezaka PR Manske (1997) ArticleTitleDifferences between locking loops and grasping loops: effects on 2-strand core suture J Hand Surg [Am] 22 995–1003 Occurrence Handle10.1016/S0363-5023(97)80038-X Occurrence Handle1:STN:280:DyaK1c7jtFyltg%3D%3D
T Tanaka PC Amadio C Zhao ME Zobitz C Yang KN An (2004) ArticleTitleGliding characteristics and gap formation for locking and grasping tendon repairs: a biomechanical study in a human cadaver model J Hand Surg [Am] 29 6–14 10.1016/j.jhsa.2003.09.017 Occurrence Handle10.1016/j.jhsa.2003.09.017
DL Pruitt M Aoki PR Manske (1996) ArticleTitleEffect of suture knot location on tensile strength after flexor tendon repair J Hand Surg [Am] 21 969–73 Occurrence Handle10.1016/S0363-5023(96)80301-7 Occurrence Handle1:STN:280:DyaK2s7isVWjtg%3D%3D
H Hatanaka PR Manske (1999) ArticleTitleEffect of the cross-sectional area of locking loops in flexor tendon repair J Hand Surg [Am] 24 751–60 10.1053/jhsu.1999.0751 Occurrence Handle10.1053/jhsu.1999.0751 Occurrence Handle1:STN:280:DyaK1MznsVygsQ%3D%3D
DG Pennington (1979) ArticleTitleThe locking loop tendon suture Plast Reconstr Surg 63 648–52 Occurrence Handle10.1097/00006534-197905000-00007 Occurrence Handle1:STN:280:DyaE1M7lvVGjuw%3D%3D Occurrence Handle372992
RH Gelberman MI Boyer MD Brodt SC Winters MJ Silva (1999) ArticleTitleThe effect of gap formation at the repair site on the strength and excursion of intrasynovial flexor tendons: an experimental study on the early stages of tendon-healing in dogs J Bone Joint Surg Am 81 975–82 10.1302/0301-620X.81B6.9700 Occurrence Handle10.1302/0301-620X.81B6.9700 Occurrence Handle1:STN:280:DyaK1MzlsFSrsQ%3D%3D Occurrence Handle10428129
Author information
Authors and Affiliations
About this article
Cite this article
Yotsumoto, T., Mori, R. & Uchio, Y. Optimum locations of the locking loop and knot in tendon sutures based on the locking Kessler method. J Orthop Sci 10, 515–520 (2005). https://doi.org/10.1007/s00776-005-0929-1
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s00776-005-0929-1