The Modified Silverskiold Tendon Repair is Stronger than the MGH and Modified Kessler Repairs
Brandon Q. Reynolds, MD, Sprague W. Hazard, MD, Randy M. Hauck, MD.
Penn State Hershey Medical Center, Hershey, PA, USA.
Modern tendon repair techniques have permitted early motion during post-operative rehabilitation to prevent adhesions. Early motion is possible due to the number of strands and thus tensile strength of repaired tendons. The most common techniques today include the modified Kessler and the MGH repairs. We have used a modified Silverskiold technique with even more strands than either of these.
Our hypothesis was that the modified Silverskiold repair would have greater tensile strength than both the MGH and modified Kessler repairs.
30 porcine flexor profundus tendons were harvested, cut and repaired. Three different types of repairs were used and analyzed: the modified Silfverskold, modified Kessler, and MGH repair. All of the repairs were completed with 4/0 prolene for the strength portion of the repair, and a 6/0 nylon in a simple running fashion for the epitendinous component of the repair. There were 10 tendons tested for each repair type for a total of 30. The tendons were then stretched to failure by linear loading on a tensiometer. Failure was designated as either pull out of the suture, rupture of the suture, or gap formation at the repair > 3mm.
The Modified Silfverskold repair had a significantly higher load tolerance then both the MGH and the modified Kessler repairs. The average force that the Modified Kessler repair withstood was 36.97 N (CI +/- 8.12). The MGH repair failed at an average of 36.57 N (CI +/- 5.3), and the Modified Silfverskiold repair failed at an average of 58.30 N (CI +/- 8.47). An ANOVA test comparing the required forces to break the repairs showed that the strength of the Silverskiold was statistically significantly greater than the other two (p< 0.0004). Most failures occurred with a 3 mm gap at the repair site, with the exception of one modified Silverskiold knot which failed.
The modified Silverskiold repair for flexor tendons is significantly stronger than either the modified Kessler or MGH repairs. This mechanically sound and simple repair provides increased strength for early rehabilitation and should decrease chances of rupture.
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