Mechanical characteristics of cross-stitch epitenon suture in association with various two-strand core sutures: a biomechanical study using canine cadaver tendons.

Abstract

The purpose of this study was to investigate the ultimate tensile strength and stiffness of the cross-stitch epitenon suture technique in association with three different two-strand core suture techniques (the modified Kessler, Tsuge, and two-strand Savage). Twenty-four canine cadaver flexor profundus tendons were lacerated and repaired by one of the following techniques: the cross-stitch (Group 1), the modified Kessler with cross-stitch (Group 2), the Tsuge with cross-stitch (Group 3), and the two-strand Savage with cross-stitch (Group 4). Ultimate strength was determined with a tensile testing machine and stiffness was recorded by a video dimension analyser system. The ultimate strength of Group 2 (5.704 kgf) was significantly greater than that of the other techniques, followed by Group 4 (4.608 kgf), Group 3 (3.568 kgf), and Group 1 (2.935 kgf). The stiffness of Group 2 (495.8 kgf/m) was significantly greater than that of the other techniques, followed by Group 4 (369.7 kgf/m), Group 3 (225.7 kgf/m), and Group 1 (200.1 kgf/m). These results may be helpful to surgeons in deciding which core suture technique to use in association with the cross-stitch epitenon suture.