Evaluation of biomechanical properties on partial and complete epitendinous suture in human cadaver flexor tendon repair

Objective: This study was designed to compare the ultimate tensile strength and force to 2 mm gap formation among 50% partial, 75% partial, and complete circumferential epitendinous suture with a combination of 4-strand core suture in human cadaver flexor tendon. Materials and methods: Forty-five flexor tendons from four soft human cadavers were used to evaluate the biomechanical property among 50% partial, 75% partial, and complete circumferential epitendinous suture with a combination of 4-strand core suture. Results: The force to 2 mm gap of complete epitendinous was significantly greater than partial epitendinous suture (P < 0.05); however, there was no difference between 50% partial and 75% partial epitendinous suture (P > 0.05). For the ultimate strength, there was no significant difference between partial and complete epitendinous suture (P > 0.05). The partial epitendinous was approximately 60% of the complete epitendinous suture in force to 2 mm gap and also 70% of complete epitendinous suture in ultimate tensile strength with a combination of core sutures. Conclusions: The complete epitendinous suture showed better ultimate tensile strength and force to 2 mm gap compared with a partial 50% and 75% epitendinous suture. However, in some clinical scenario which the complete epitendinous suture is not possible to perform, the authors suggested only partial epitendinous suture with 50% circumference is recommended as the additional epitendinous repair up 75% circumference cannot provide any mechanical benefit to the repaired site.