Flexor tendon repair using the two-strand side-locking loop technique to tolerate aggressive active mobilization immediately after surgery

BACKGROUND: Early mobilization after tendon repair decreases adhesion formation and improves repair-site strength. We investigated whether the two-strand side-locking loop technique would tolerate aggressive active mobilization immediately after surgery. METHODS: Twelve flexor digitorum profundus tendons of the porcine forelimbs were sutured by the two-strand side-locking loop technique with a cross-stitch epitendinous repair (Group A), and by the 8-strand repair method with a simple running suture (Group B). Gaps and residual tensile strength after cyclic loadings of 3-50 N (for 10,000 rounds) were measured. FINDINGS: Gaps after cyclic loading in Group A were 0.5+/-0.3 and 1.2+/-0.8 mm while those in Group B were 3.5+/-0.8 and 5.2+/-1.2 mm at 3 and 50 N, respectively. In addition, the respective residual tensile strength of Groups A and B were 207.1+/-15.2 and 84.2+/-18.3N. INTERPRETATION: A combination of the two-strand side-locking loop technique with cross-stitch epitendinous repair served as the optimum suture method in establishing safe and early active mobilization without the aid of a specialized rehabilitation staff.