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Background: Early motion after tendon repair has been shown to decrease adhesions and improve range of motion, but requires a strong tendon repair. The greater the number of suture strands crossing a tendon repair site, the stronger the repair. This study assesses a repair which provides approximately 10-14 strands at the repair site. The pattern is based on a described epitendinous repair, the Silfverskiöld. We have modified this to function as the strength portion of the repair, and call it the Modified Silfverskiöld.
This study compares the breaking strength of 3 different tendon repairs: MGH, Modified Kessler, and Modified Silfverskiöld.
Methods: Thirty porcine flexor tendons were repaired with the Modified Silfverskiöld, Modified Kessler, or MGH repair (10 each). All repairs were completed with 4/0 prolene strength portion of the repair, and a simple running 6/0 nylon epitendinous component. The tendons were loaded to failure on a tensiometer. Failure was designated as pull out of the suture, rupture, or gap formation at the repair > 3mm.
Results: The Modified Silfverskiöld repair had a significantly higher load tolerance. The average force that the Modified Kessler repair withstood was 36.97 N. The MGH repair failed at an average of 36.57 N, and the Modified Silfverskiöld repair failed at an average of 58.30 N. All failures were classified as a > 3 mm gap at the repair site, with the exception of one Modified Silfverskiöld knot which failed.
Conclusions: The Modified Silfverskiöld repair is significantly stronger than either the Modified Kessler or MGH repairs.