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Knotted Versus Knotless Techniques for Digital Flexor Tendon Repair: A Cadaveric Biomechanical Study
Alexander J. Kammien
*, Fortunay Diatta, Lynn Zhao, Haripriya Ayyala, David L. Colen
Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT
Purpose: The current study compared work of flexion and strength of digital flexor tendon repairs using knotted and knotless techniques.
Methods: Two knotted and two knotless techniques for flexor tendon repair were assessed. Each repair was tested in twelve cadaveric flexor digitorum profundus (FDP) tendons. Work of flexion prior to repair was determined. FDP tendons were lacerated between the A2 and A4 pulleys and repaired using 3-0 braided or 2-0 barbed suture. Work of flexion measurements were repeated. FDP tendons were removed from the hand, and load to 2mm gap and failure were recorded. One-way analysis of variance and t-tests were used for statistical analysis.
Results: Overall, knotted repairs had smaller increases in work of flexion than knotless repairs (106% vs 117%, p=0.020). There were significant differences in work of flexion among individual techniques (p=0.023). The novel knotless technique, compared to the previously published knotless technique, had lower increase in work of flexion that approached significance (110% vs 123%, p=0.073). Increase in work of flexion with the novel technique was similar to the knotted techniques, while the increase in work of flexion with the previously published knotless technique was significantly greater than the knotted techniques (Figure 1). There was no difference in load to 2mm gap formation between braided and barbed techniques (38N vs 38N, p=0.779). Knotted techniques had greater load to failure (56N vs 46N, p=0.001). All knotless techniques failed by pull-through, while only 46% of knotted techniques failed by pull-through.
Conclusions: Knotted techniques demonstrated smaller increases in work of flexion than knotless techniques
. One knotless technique had similar work of flexion to knotted techniques, while the other showed greater increases in work of flexion
. Compared to knotted techniques, knotless techniques had similar load to 2mm gap formation but lower load to failure
.
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