Biomechanical Evaluation of a Tubular Braided Construct for Primary Deep Flexor Tendon Surgery

Purpose Immediate postoperative mobilization has been shown to avoid adhesion formation and improve range of motion after flexor tendon repair. A tubular braided construct was designed to allow for these rehabilitation protocols. Methods In this ex vivo study, 92 ovine flexor tendons were divided randomly into 2 equal groups. After creating a transection, the tendons of the first group were repaired using a tubular braided construct. This construct, consisting of a tubular braid of polypropylene and polyethylene terephthalate fibers, exerts a grasping effect on the tendon ends. The control group received a multistrand modified Kessler repair with a looped polydioxanone suture (PDS) 4-0 suture and a Silfverskiold epitendinous repair using an Ethilon 6-0 suture. After the repair, a static and an incremental cyclic tensile test was performed until failure. Results During the static test, the tubular braid resulted in a significantly higher load at 3 mm gap formation (86.3 N +/- 6.0 vs 50.1 N +/- 11.6), a higher ultimate load at failure (98.3 N +/- 12.7 vs 63 N +/- 11.1), higher stress at ultimate load (11.8 MPa +/- 1.2 vs 8.1 MPa +/- 3.1), and higher stiffness (7.1 N/mm +/- 2.9 vs 8.7 N/mm +/- 2.2). For the cyclic tests, survival analyses for 1-, 2-and 3-mm gap formation and failure demonstrated significant differences in favor of the tubular braided construct. Conclusion The tubular braided construct withstands the required loads for immediate rehabilitation not only in static tests, but also during cyclic tests. This is in contrast with the control group, where sufficient strength is reached during static tests, but failures occur below the required loads during cyclic testing. Clinical relevance The tubular braided construct provides a larger safety margin for immediate intensive rehabilitation protocols. (J Hand Surg Am. 2023;48(10):1057.e1-e7. Copyright (c) 2023 by the American Society for Surgery of the Hand. All rights reserved.)