Abstract
Background The placement of multistrand sutures during flexor tendon repair requires complicated
surgical skills; such suturing is difficult. We developed a new, simpler eight-strand
suture, which we term the Yoshizu cross-lock. This reduces the numbers of suture passages
through the tendons, as well as the numbers of knots.
Methods Fourteen porcine flexor tendons were transected and repaired using the Yoshizu cross-lock
system; no peripheral sutures were placed. Our system is a modification of the published,
exposed cross-lock repair method that employs a 4–0 monofilament nylon two-strand
line and two needles. The repaired tendons were subjected to linear, noncyclic load-to-failure
tensile testing. The initial gap, the 2-mm gap force, and the ultimate strength were
measured.
Results The initial gap force was 12.6 ± 5.6 Newtons (N), the 2-mm gap force was 33.9 ± 10.9 N,
and the ultimate strength was 70.1 ± 17.0 N. All tendons subjected to Yoshizu cross-lock
repair failed due to suture rupture rather than pullout.
Conclusions Our biomechanical study revealed that Yoshizu cross-lock repair had sufficient tensile
strength but was associated with wide variation in the 2-mm gap load (standard deviation = 10.9 N).
This study is clinically relevant, showing that the Yoshizu cross-lock repair combined
with peripheral suturing may allow a repaired flexor tendon to withstand the stresses
encountered during early active mobilization. This simple eight-strand technique will
be particularly useful to surgeons who commonly employ the cross-lock stitch for primary
flexor tendon repair following early mobilization.
Keywords
cross-locking - eight-strand - flexor tendon repair
