A biomechanical analysis of the modified Tsuge suture technique for repairof flexor tendon lacerations

Thirty-six flexor tendons from fresh frozen cadavers were randomized to thr ee types of repairs: a Kessler-Tajima, a 4-strand modified Tsuge, and a 6-s trand modified Tsuge. All repairs were accompanied by a standard epitendino us suture. The repaired tendons were then tested to initial gap and ultimat e failure in an Instron machine. The average forces to ultimate failure wer e 31.8 N (SD, 8.8), 48.4 N (SD, 10.7), and 64.2 N (SD, 11.0) respectively. The 6-strand modified Tsuge suture was significantly stronger than the othe r repairs and the 4-strand modified Tsuge was significantly stronger than t he 2-strand Kessler-Tajima. The 6-strand and 4-strand modified Tsuge repair s appear strong enough to withstand the forces generated during early activ e range of motion flexor tendon rehabilitation protocols. Clinical trials a re required to evaluate the usefulness of these repairs.