All-Suture Anchor Repair of the Flexor Digitorum Profundus Insertion: A Biomechanical Comparison of 2 Suturing Techniques

Christopher M Belyea; Pooyan Abbasi; Kavya K Sanghavi; Aviram M Giladi; Kenneth R Means Jr

doi:10.1016/j.jhsa.2022.05.003

All-Suture Anchor Repair of the Flexor Digitorum Profundus Insertion: A Biomechanical Comparison of 2 Suturing Techniques

J Hand Surg Am. 2023 Dec;48(12):1276.e1-1276.e7. doi: 10.1016/j.jhsa.2022.05.003. Epub 2022 Jun 29.

Authors

Christopher M Belyea¹, Pooyan Abbasi², Kavya K Sanghavi², Aviram M Giladi², Kenneth R Means Jr³

Affiliations

¹ The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD; Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD.
² The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD.
³ The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD. Electronic address: editor@curtishand.com.

PMID: 35778231
DOI: 10.1016/j.jhsa.2022.05.003

Abstract

Purpose: We compared 2 suturing techniques for reattachment of the flexor digitorum profundus (FDP) via all-suture anchor.

Methods: We used fresh, matched-pair, cadaveric hands. We disarticulated the fingers at the proximal interphalangeal joints, preserving the proximal FDP. We released the FDPs at their distal insertion and placed an all-suture, 1.0-mm anchor at the center of each FDP footprint. Each anchor's sutures were used to reattach each FDP using 1 of 2 techniques: group H (n = 14) via horizontal mattress; group H + K (n = 12) via horizontal mattress with knots thrown and, with each suture tail, 3 proximal, running-locking, Krackow-type passes on the radial and ulnar FDP sides with the suture ends tied together. We excluded 2 specimens from the H + K group because of improper anchor placement. All other fingers in both groups were individually mounted in an MTS machine for FDP loading in the following sequence for 500 cycles each: (1) to 15 N to simulate passive motion forces; (2) to 19 N for short-arc active motion forces; and (3) to 28 N for full active motion forces. Specimens that had not failed during cyclic testing were then loaded to failure. We measured FDP-to-bone gapping via a digital transducer. We defined failure as >3-mm gapping.

Results: The H + K group had significantly less gapping during cyclic loading up to 19 N and significantly higher load to failure. The H + K group failed exclusively at the anchor-bone level; the H group failed mostly by suture-tendon pullout.

Conclusions: The H + K group performed significantly better regarding cyclic and load-to-failure testing after FDP reattachment.

Clinical relevance: The H + K technique combines the benefits of horizontal-mattress tendon-to-bone apposition and Krackow-tendon locking. It converts the point of failure to the bone level rather than the suture-tendon level.

Keywords: All-suture anchor; Krackow; flexor digitorum profundus; jersey finger; tendon avulsion.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Biomechanical Phenomena
Cadaver
Finger Injuries* / surgery
Humans
Suture Anchors
Suture Techniques
Tendon Injuries* / surgery
Tendons / surgery