BIOMECHANICAL ANALYSIS OF THE SILVERSJOLD EPITENDINOUS SUTURE TECHNIQUE WITH VARYING WIDTHS OF REPAIR

Abstract

Aim: To compare strength the to failure of Silversjold type B repair (SJBR) using bites two, four and six millimetres from the repair site of an ex-vivo porcine flexor tendon model.

Methods: Seventy freshly harvested procine flexor tendons were transected and randomised to repair using either SJBR or simple running epitendinous repair with and without a two strand Modified Kessler repair (MKR), repairs also performed spanning four and six millimetres from the repair site.

Biomechanical testing was performed with a Zwig tensinometer using a one neuton preload and a distraction rate of 20mm/min. Bulking was measured with a digital micrometer and each repair group was tested for mean load to repair failure and mean load to 2mm gap formation. In each case the mechanism of failure was recorded.

Results: The addition of an epitendonous suture statistically increases strength to failure over a core suture alone. The SJB with MKR at all distances was stronger than the the standard epitendonous suture with MK. Optimal strength was obtained at a distance of 6mm from the repair site. Data was assesed using an ANOVA analysis. Repairs failed in all repairs by suture breakage.

Conclusion: The use of an epitendonous suture adds valuable strength to a flexor tendonn repair. The SJBR is somewhat more complicated that a standard running suture however the augmentation in strength makes this worthwhile. The placement of IHM is optimal at 6mm from the repair site and did not statistically increase the tendon bulk.