An ex vivo biomechanical study comparing strength characteristics of a new technique with the three-loop pulley for equine tenorrhaphy.

Objective: To test single cycle to failure tensile strength characteristics of 6 suture material-pattern combinations in equine superficial digital flexor (SDF) tenorrhaphy, specifically to compare a 10-strand modification of the Savage core suture technique with the 3-loop pulley technique.

Study Design: Ex vivo mechanical experiment comparing 3 different suture patterns with 2 different materials.

Sample Population: Forelimb and hindlimb SDF tendons (n=48) harvested from adult Thoroughbred and Standardbred horses of mixed age and gender.

Methods: Six suture material-pattern combinations were evaluated: (1) 10-strand Savage, size 2 polydioxanone (PDS); (2) 10-strand Savage, size 2 polyglactin 910 (PG910); (3) 10-strand Savage, size 2 PDS with Lin-locking epitenon suture, size 2-0 PDS; (4) 10-strand Savage size 2 PG910 with Lin-locking epitenon suture, size 2-0 PDS; (5) 3-loop pulley, size 2 PDS; and (6) 3-loop pulley, size 2 PG910. Maximum load at failure (N), gap at failure (mm), and mode of failure (suture breakage or pull through) were evaluated for each of the 6 suture material-pattern combinations and underwent statistical analysis to determine significance of differences and interactions of the measured data.

Results: The 10-strand Savage technique failed at a mean load of 872 (804-939, 95% CI). The 10-strand Savage with Lin-locking failed at a significantly greater mean load of 998 (930-1065, 95% CI). The 3-loop pulley pattern failed with a mean load of 337 (270-405, 95% CI). There were significant interactions between the technique and suture material used.

Conclusion: The 10-strand Savage technique for repair of transected cadaver SDF tendons has superior strength characteristics with or without the epitenon suture when compared to the 3-loop pulley. Suture material and pattern interactions were observed with PG 910 conferring higher strength for the 10-strand Savage whereas PDS did so for the 3-loop pulley.