The results of Zone 2 Flexor tendon Repair with Four Strand Cruciate Suture Technique

Volume 12 | Issue 4 | Oct-Dec 2017 | Page 13-16 | Ashutosh Bhosale, Amol Dhawale

Authers: Ashutosh Bhosale [1], Amol Dhawale [1].

[1]Morya Foundation Hospital & Research Centre, Satara.

Address of Correspondence
Dr. Ashutosh H. Bhosale
Consultant, Dept. of Orthopedics,
Morya Foundation Hospital & Research Centre, Satara
Email –


Background: Introduction:The zone 2 flexor tendon injury is a common problem in clinical practice. Although many suture techniques are popular like Kessler, Modified Kessler, Bunnell, Savage, Lee, and Tsuge with their peculiarities none of them meet an ideal suture technique criteria. In this quest of an ideal tendon suture technique, Four Strand Cruciate design appears a strong contender in recent literature. The purpose of this study is to assess functional outcome of zone 2 flexor tendon repairs by Four Strand Cruciate suture design.
Materials & Methods: A consecutive group of patients with zone 2 flexor tendon injuries of hand were repaired with four strand cruciate technique during January 2014 to December 2015. This repair has 4 strands with a cruciate design at the repair site. It is a grasping type with knot coming away from the repair site. The postoperative protocol included Kleinert traction and Modified Brook Army Hospital regimen. Functional outcome was assessed by validated scores like Total Active Motion (TAM), Modified Strickland functional score, Quick DASH score.
Results: Between January 2014 to December 2015, 27 fingers with cut flexor tendons were sutured by this method. Average total activity motion (TAM) at 3 months was 51% and at 6 months it was 63%. At 3 months, by Modified Strickland Grading, 9 fingers rated excellent or good (33.33%) while 18 fingers rated fair (66.67%). At 6 months, 21 fingers (77.78%) rated excellent or good while 6 fingers were rated fair (22.22%). There were no poor results. The average QDASH at 3 months was 24.96 while at 6 months it was 11.59. Three fingers had re-rupture while 6 fingers had adhesions.
Conclusion: The results of flexor tendon repair with this method are up to the mark as compared to present literature with overall good patient satisfaction (QDASH).Four Strand Cruciate with high tensile strength and gap resistance can allow us to use aggressive post repair rehabilitation protocols. Thus the Four Strand Cruciate with its peculiarities causes fewer complications like re-ruptures and adhesions.,
Keywords: zone 2 flexor tendon injury, Four Strand Cruciate suture design, functional outcome


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How to Cite this article:  Bhosale A, Dhawale A. The results of zone 2 flexor tendon repair with Four Strand Cruciate suture technique. Journal of Trauma and Orthopaedic Surgery. July – Sep 2017;12(4):13-16.

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