It is well accepted that early mobilisation is essential following flexor tendon repair to prevent adhesion formation and promote improved post-operative tendon healing and optimise functional outcome. To allow early mobilisation there must be sufficient strength at the repair site to resist gap formation and subsequent rupture. Number of core suture strands crossing the repair site has been shown to be one of many factors affecting its strength. There are several lab-based biomechanical studies demonstrating the superiority of 8-strand, 6-strand and 4-strand core techniques over 2-strand repairs with regard to ultimate tensile strength, gap formation and tendon gliding. This must be balanced with technical difficulty, minimisation of tendon handling and bulkiness of the repair. Traditionally, our unit employed the Adelaide 4-strand core repair due to ease of technical application and improved results over 2-strand repairs.
There is a lack of clinical outcome studies comparing 4-strand and 6-strand flexor repair in the literature. Our objective is to compare the outcomes of the evidence-based improved strength of the 6-strand technique, simplified by applying the M-Tang approach with traditional 4-strand Adelaide repair previously applied to our zone 2 flexor tendon injuries.
If we can show superior strength of this repair v 4-strand repair we will change our clinical practice to implement this new technique instead of the older technique in attempt to improve our patient outcomes.