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Flexor Tendon Repair with Looped Suture: One vs Two Knots
Joseph A. Gil, MD; Christian Skjong, MD; Julia A. Katarincic, MD; Christopher Got, MD
Brown University, Providence, RI

Introduction: The use of looped suture in flexor tendon repair has facilitated multi-core repair with fewer needle passes and less tissue handling. We hypothesize that, after passing looped suture in the desired repair configuration, splitting the loop and tying two independent knots instead of a single knot increases the strength of flexor tendon repair.
Materials & Methods: Flexor digitorum profundus and flexor digitorum superficialis tendons were harvested and transected (n=32). The tendons were repaired with a 4-strand core suture repair completed with 3-0 looped Supramid suture. The harvested tendons were randomly assigned and repaired with either a one or two knot construct. The repaired flexor tendons were fixed to a MTS and were either loaded to failure with uniaxial tension or cyclically.
Results: The mode of failure in load to failure testing for the one knot flexor tendon repair was suture rupture for 4 repairs (50%) and suture pull out for 4 repairs (50%) whereas the mode of failure for the two knot repair was suture pullout for all 8 repairs performed (100%). The average force at failure was 43.01 N 14.22 N (28.79 to 52.87) for the one knot repair and 25.04 N 9.28 N (18.33 to 37.12) for the two knot repair (p=0.031). The mode of failure of 15 (100%) of the flexor tendon repairs that were cyclically loaded to failure was suture pullout. The average number of cycles and force in cyclic testing that caused failure of flexor tendon repairs was 134.71 cycles 65.77 (95% CI, 68.95 to 183.43) and 31.08 N 4.89 (95% CI, 26.19 to 34.70) for tendons repaired with looped 3-0 suture tied with one knot and 94.25 cycles 107.03 (95% CI, -12.79 to 168.42) and 32.98 29.05 (95% CI, 3.93 to 53.11) for tendons repaired with looped 3-0 suture tied with two knots (p>0.05).
Conclusion: This study suggests that when using looped suture, tying two independent knots instead of tying a single knot does not increase the strength of the flexor tendon repair.

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