Comparing Suture Techniques for Flexor Tendon Repair: A Systematic Review and Literature Study

Background: Flexor tendon injuries continue to be a major cause of illness among young males. Since the tendon's primary role is force transmission, the repair's strength is crucial because it must be able to sustain the high stresses. This has led to numerous suturing methods in the literature, mostly focused on improving repair strength and refining effective techniques. Methods: "Suture" AND "Techniques" OR “Knots” AND "Flexor Tendon" OR “Flexor” AND "Repair" were used to search Pubmed, the Cochrane Library, and Wiley online. (MeSH keywords) in the abstract or title field between January 1, 2020 to December 31, 2024. Using standard techniques, the quality of published papers was evaluated. We included observational and experimental research, including cross sectional, cohort, randomized control trials, and case series. Results: Eight studies were found to meet the inclusion criteria after the studies and their reference lists were screened. Kessler's and modified Kessler's sutures were among the first and most popular core suture configurations. All studies indicated that multistrand suture technique significantly improve gap resistance, allowing early mobilization of the affected digit. Only passive mobilization techniques are possible with a two-strand repair, at least four strands are required for active mobilization. Conclusion: The strength of the flexor tendon repair especially depends on the number of strands crossing the repair site, because strength is increased with an increase in the number of core strands. Multistrand suture technique can greatly increase the gap resistance of surgical repair, facilitating early mobilization of the affected digit Keywords: flexor tendon injury, repair, suture technique