Effect of bite distance of an epitendinous suture from the repair site on the tensile strength of canine tendon constructs

Authors: 
Duffy DJ, Cocca CJ, Kersh ME, Kim W, Moore GE.
Am J Vet Res. 2019 Nov;80(11):1034-1042. doi: 10.2460/ajvr.80.11.1034.

OBJECTIVE: To evaluate effects of bite distance of an interlocking horizontal mattress epitendinous suture (IHMES) from the repair site on tensile strength of canine tendon repairs.

SAMPLE: 72 canine cadaveric superficial digital flexor tendons (SDFTs).

PROCEDURES: Transverse tenotomy was performed, and SDFTs were repaired with a locking-loop construct (LL construct) or 3 LL constructs with IHMES suture bites placed 5 (LL + 5ES construct), 10 (LL + 10ES construct), or 15 (LL + 15ES construct) mm from the transection site (18 SDFTs/group). Constructs were loaded to failure. Load at 1- and 3-mm gapping, yield force, failure load, and failure mode were evaluated.

RESULTS: Mean ± SD yield force and failure load for LL constructs were significantly lower than for IHMES constructs. Load at 1- and 3-mm gapping was significantly higher for IHMES constructs. Increasing the bite distance significantly increased construct strength (134.4 ± 26.1 N, 151.0 ± 16.8 N, and 182.1 ± 23.6 N for LL + 5ES, LL + 10ES, and LL + 15ES constructs, respectively), compared with strength for the LL construct. Failure mode differed significantly among constructs when an IHMES was used.

CONCLUSIONS AND CLINICAL RELEVANCE: Addition of an IHMES to an LL construct led to increased ultimate tensile strength by 2.5 times and significantly reduced gap formation. Increasing the IHMES bite distance increased yield force by 2.1, 2.3, and 2.7 times for bites placed 5, 10, and 15 mm from the tenotomy, respectively. Positioning an IHMES at a greater distance from the repair site provided superior biomechanical strength for tendon repairs in dogs.