Comparative biomechanical study between the Adelaide suture and local modification for flexor tendon injuries in a cadaver model

Abstract

Background: Blocked configurations in tendon repair offer higher tensile strength to cavitational spaces in the area of attachment of sectioned tendon ends, when compared to configurations with more grip. The objective of this study is to evaluate the biomechanical behavior of the Adelaide stitch suture (double-double crossover blocked) compared to a local modification (triple cross-double locked) in the tendons of a Colombian population.
Methods: Ten human tendons obtained from a dissected cadaver, with eight corresponding to the flexor digitorum profundus and two of them to the flexor pollicis longus. A cross-section was performed on each tendon at zone II, followed by tenorrhaphy using 3-0 braided green polyester (Ethibon). Each tenorrhaphy was subjected to a failure load test (Universal Testing Machine Shimadzu, software: Trapezium 2.0). Two groups, each one with five tendons, were used to compare the biomechanical behavior between the Adelaide suture and the local modification.
Results: The final load failure was similar in both groups. No significant differences were found in the point of stitch suture dehiscence at 2 mm, with mean values of 40 N in the Adelaide suture and 39 N in the group with the local modification suture technique. In 70% of cases, a material failure occurred, without the loss of the suture configuration. Only in 30% of cases was the failure due to tear of the tendon suture.
Discussion: The findings showed biomechanical advantage to four strands of sutures, as well as their reproducibility over the surgical technique. The lack of findings on the material suggest that clinical research should focus on introducing stronger sutures rather than changing surgical techniques.