Table 1.
Flexor tendon suture configurations.
Fig 1.
(A-C) The three suture passes required to make a single half hitch loop are shown sequentially as an end view from the transection interface, a side view, and a perspective view. This is a continuous piece of suture, where suture coloration is artificially added to aid in following the suture path, going from blue to purple. The suture diameter is enlarged two-fold for clarity. Looped suture is used surgically, but only one of each pair of suture threads is diagrammed here for simplicity. (D) The complete half hitch loop configuration is enlarged for clarity. (E-F) The locations of half hitch loops are shown in green for 4-strand modified Kessler (E) and 8-strand Winters-Gelberman (F) repairs. In 8-strand repairs, the first four passes were performed on the dorsal side and the last four passes were performed on the ventral side of the tendon.
Table 2.
Mechanical properties of repairs (mean ± standard deviation).
Fig 2.
Load creating a 2 mm gap, maximum load, and resilience were significantly improved with the addition of half hitch loops in 8 strand repairs. (G: grasping, H: hitched, * p < 0.05, mean ± standard deviations are shown).
Fig 3.
Repairs completed with 4–0 caliber suture failed almost exclusively by suture breakage. Increasing suture caliber from 4–0 to 3–0 led to a shift in failure mode from suture breakage to suture pullout. The addition of half hitch loops shifted the failure mode in 3–0 suture caliber repairs back to suture breakage, indicating a significant increase in suture-tendon interaction due to the hitches. (G: grasping, H: hitched, K: hitched knotless).
Fig 4.
Mechanical properties of knotless repairs.
Load creating a 2 mm gap, maximum load, and resilience significantly improved with the addition of half hitch loops. Knotless repairs were either equivalent (load creating a 2 mm gap) or improved (maximum load and resilience) compared to a standard Winters-Gelberman 8-strand repair (G: grasping, H: hitched, K: hitched knotless, * p < 0.05, mean ± standard deviations are shown).