Evaluation of hollow mesh augmentation on the biomechanical properties of the flexor tendon repaired with modified Kessler technique

Purpose: The aim of the study was to test flexor tendon repair with a novel hollow mesh suture augmentation served as a centre core cable [Triple-C (Tri-C)] in an in vitro study using a turkey model. Methods: Forty long digits from white turkey feet were divided into the following four groups based on repair techniques: Group 0, intact tendon without repair; Group 1, modified Kessler (MK) repair only (MKo); Group 2, MK repair plus Tri-C (MK ​+ ​Tri-C); and Group 3, MK repair plus an additional outside knot plus Tri-C (MK-2knots ​+ ​Tri-C). Mechanical evaluations were performed for all groups. Results: The frictions of the two groups with Tri-C were not significantly different than those of the MKo group. The ultimate tensile strength of the MK ​+ ​Tri-C group was not significantly different from that of the MKo group or the MK-2knots ​+ ​Tri-C group. In contrast, the MK-2knots ​+ ​Tri-C group had a significantly greater ultimate tensile strength compared with that of the MKo group. Forces at 2-mm gap formation in the groups with Tri-C were significantly stronger than that of MK alone. Conclusion: Our data have demonstrated that MK repair augmented with the centre hollow mesh suture increased failure strength without inducing increased friction. The translational potential of this article: Our study elucidates that a Tri-C augmentation designed in this study can achieve mechanical enhancements without increasing the repaired tendon friction. Hence, this novel technique has potential biological validity and clinical application.