Biomechanical Comparison of Jersey Finger Repair Methods Including Novel All-Suture Technique
Alexandria J Sherwood, MD1; Conor S Daly-Seiler, MS1; Brian W Starr, MD2; Jeffrey N Lawton, MD3; John Lien, MD1
1University of Michigan, Ann Arbor, MI; 2University of Cincinnati, Cincinnati, OH; 3Orthopaedic Surgery, University of Michigan, Ann Arbor, MI
Introduction Repair of zone 1 flexor digitorum profundus (FDP) avulsions, or jersey fingers, can be accomplished in many ways. No true gold standard fixation method has been established due to known complications of popular repair methods as well as prohibitive cost of anchor repair techniques. We hypothesize that a novel, all-suture method with two overlapping suture limbs through distal phalanx bone tunnels resulting in a volar knot for jersey finger repair will exhibit non-inferior biomechanics to both anchor fixation and a previously described all-suture method.
Materials & Methods Eighteen cadaver fingers were used for repairs (n=6 per group). Repairs included an all-suture method with locking Krackow suture in tendon using 3-0 Vicryl leaving two suture tails exiting from the distal tendon. One of the two tails was then passed through two bone tunnels in the distal phalanx from volar to dorsal then dorsal to volar and tied with remaining suture tail. The novel, all-suture method was completed with locking Krackow suture in tendon again with two suture tails, however, each tail was passed through two bone tunnels as above in mirror fashion and tied volarly over the FDP footprint. Finally, the suture anchor repair used two Arthrex Nano Corkscrew anchors and locking Krackow suture in tendon (Arthrex, Naples, FL). Each repair method was subjected to the same protocol of biomechanical testing including pre-tensioning and load-to-failure utilizing the MTS Mini Bionix servo hydraulic system (MTS Systems, Eden Prairie, MN).
Results There were no statistical differences in ultimate load-to-failure between the three groups (p = 0.058) with similarity in mean ultimate load-to-failure between the novel repair method and anchor groups (74.51 N vs 75.98 N). There was also no difference in work-to-failure between groups (p=0.43). The standard all-suture repair group exhibited less stiffness than the novel technique and anchor repair groups (p = 0.002). Thirteen specimens, including all the all-suture repair methods, failed by gap formation at the repair site. The remaining 5 anchor repair specimens failed by either anchor pullout (n=2), including one which simultaneously fractured the distal phalanx, or suture breakage at suture-anchor interface (n=3).
Conclusion This biomechanical study of cadaveric jersey finger repair methods showed non-inferiority of a novel, all- suture limb repair with overlapping suture tails through bone tunnels when compared to anchor fixation in tensile stiffness, ultimate load-to-failure, or work-to-failure. These findings support use of this novel fixation method while avoiding the shortcomings of anchor fixation.
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