The influence of oblique sutures and tendon-suture anchorages on tensile resistance and ultimate strength of 4-strand tendon repairs

This study investigated whether the integration of the oblique sutures contributes to the resistance to gapping in 4-strand flexor tendon repairs. In 72 porcine tendons, we compared repairs incorporating oblique sutures against those without using three distinct anchorage types. The studied suture configurations were longitudinal and oblique, modified Savage and Adelaide, and modified Kessler and Lahey. The number of tendons that formed the first gap or a 2 mm gap at the repair site during cyclic loading, stiffness at the 1st and 20th cycles, gap size between tendon ends and ultimate strength were recorded. No significant differences were found between core sutures with and without oblique sutures except between the modified Savage and Adelaide sutures. The Kessler-type anchorage was inferior in resisting gap formation than simple grasping or cross-locking sutures. We conclude that an oblique suture does not increase the gap resistance of 4-strand tendon repairs when using grasping or Kessler-type anchorages, but it does when using a cross-locking anchorage, such as the Adelaide suture. Simple grasping anchorage is comparable to cross-locking in resisting gap formation.