A Biomechanical Analysis of the Modified Tsuge Suture Technique for Repair of Flexor Tendon Lacerations

Abstract

Thirty-six flexor tendons from fresh frozen cadavers were randomized to three types of repairs: a Kessler-Tajima, a 4-strand modified Tsuge, and a 6-strand modified Tsuge. All repairs were accompanied by a standard epitendinous suture. The repaired tendons were then tested to initial gap and ultimate failure in an Instron machine. The average forces to ultimate failure were 31.8 N (SD, 8.8), 48.4 N (SD, 10.7), and 64.2 N (SD, 11.0) respectively. The 6-strand modified Tsuge suture was significantly stronger than the other repairs and the 4-strand modified Tsuge was significantly stronger than the 2-strand Kessler-Tajima. The 6-strand and 4-strand modified Tsuge repairs appear strong enough to withstand the forces generated during early active range of motion flexor tendon rehabilitation protocols. Clinical trials are required to evaluate the usefulness of these repairs.