Date of Award

January 2025

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

David L. Colen

Abstract

Background: Few prior studies have investigated work of flexion following knotless digital flexor tendon repair using barbed suture. Existing evidence is mixed: some studies report no difference between knotted and knotless techniques, while others show increased work of flexion with knotless techniques. This biomechanical study aimed to strengthen current evidence by comparing knotted and knotless flexor tendon repairs.

Methods: Two knotted and two knotless techniques for flexor tendon repair were evaluated. Each repair was tested in twelve cadaveric flexor digitorum profundus (FDP) tendons. Work of flexion was measured prior to repair. FDP tendons were lacerated and repaired using knotted or knotless techniques. Work of flexion measurements were repeated. FDP tendons were removed from the hand, and load to 2mm gap and failure were recorded. Statistical analysis included one-way analysis of variance and t-tests.

Results: Overall, knotless repairs demonstrated greater increases in work of flexion than knotted repairs. Among individual techniques, one knotless technique demonstrated similar increases in work of flexion to knotted techniques, while the other knotless technique showed significantly greater increases in work of flexion. There was no difference in load to 2mm gap formation between knotted and knotless techniques; however, knotted techniques had greater load to failure.

Conclusion: Some knotless techniques for digital flexor tendon repair may perform similarly to knotted techniques in the immediate postoperative period. Further research is necessary to determine the effects of knotless techniques on tendon healing and functional outcomes.

Comments

This is an Open Access Thesis.

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