A Loop-Tendon Suture for Tendon Transfer or Graft Surgery

PurposeWe present a loop-tendon suture technique that was designed for easy tension adjustment and early postoperative rehabilitation in tendon transfer or graft surgeries. This study tested the biomechanical strength of the loop-tendon suture by using chicken flexor tendons and we report the preliminary clinical results.MethodsWe tested the ultimate strength of the loop-tendon suture against the end-weave suture technique in chicken flexor tendons. Forty flexor digitorum longus tendons of chickens were divided into 2 groups according to the suture technique, loop-tendon suture and end-weave suture groups, and then were subjected to linear loading in a tensile load testing machine. From 2000 to 2002 we performed 27 tendon transfer surgeries clinically, including 4 interpositional tendon grafts in 15 patients, using this technique followed by immediate passive motion exercise after surgery. The mean follow-up time was 20 months.ResultsThe ultimate tensile load of chicken flexor tendons was 31 ± 6 N for the loop-tendon suture group and 23 ± 8 N for the end-weave suture group, and the difference was statistically significant. Clinically, 6 patients with an extensor indicis proprius to an extensor pollicis longus transfer showed more than good results in the Geldmacher scheme. Three patients with an extensor indicis proprius to a central tendon transfer achieved proximal interphalangeal extension of less than 15° of extension lag. One patient with a flexor digitorum profundus reconstruction obtained total active motion of 210°. The 5 patients with triple transfers for radial nerve palsy showed more than neutral extension of the wrist and metacarpal joint. There were no tendon ruptures.ConclusionsThe loop-tendon suture method has greater strength than the conventional end-weave technique, and can be used for secondary tendon reconstruction surgery with favorable clinical outcomes.Type of Study/level of evidenceTherapeutic IV.