Article

Tendon grafts are a component of the therapeutic arsenal for managing chronic
flexor tendons injuries in the hand, especially during two-stage Hunter
reconstruction. The purpose of this anatomical study was to compare the strength
of the Pulvertaft weave versus the step-cut suture used for flexor tendon
reconstruction to determine their role in early active mobilization. We performed
a biomechanical study with cadaver specimens. Thirty-four hands were randomized
and the tendons from both hands were equally assigned to each group. A comparison
of the Pulvertaft weave (group 1) versus the step-cut suture (group 2) using the
flexor digitorum profundus from the fourth finger and the longus palmaris was
carried out. The main variable was the failure load in both repair groups. We
also evaluated the cross-sectional area (CSA) and the tensile strength of the
repairs. Thirty hands were included in our study. There was no significant
difference in the failure load between the two groups (116N for group 1 versus
103N for group 2, P=0.2). The CSA was significantly smaller in the step-cut group
compared to Pulvertaft group (19.8mm(2) versus 35mm(2), P<0.01). The tensile
strength was significantly higher in the step-cut group than in the Pulvertaft
group (5.3N/mm(2) versus 3.4N/mm(2), P<0.01). Early active mobilization requires
a minimum repair strength of 75N. In our study, the step-cut suture appears
strong enough and thin enough to decrease the fibrosis, which would lead to
better functional results. No other study of this type has been published. The
specimens in which the repair strength was less than 75N all involved a thin,
weak longus palmaris. Other biomechanical studies should be done to define the
anatomical criteria required for use of the palmaris longus tendon. The step-cut
suture seems to be strong enough and thin enough to provide sufficient proximal
attachment during flexor tendon reconstruction to allow early active
mobilization.
CI - Copyright (c) 2017. Published by Elsevier Masson SAS.

Langue : ANGLAIS