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The Journal of Bone and Joint Surgery (American) 86:320-327 (2004)
© 2004 The Journal of Bone and Joint Surgery, Inc.

Digital Resistance and Tendon Strength During the First Week After Flexor Digitorum Profundus Tendon Repair in a Canine Model In Vivo

Chunfeng Zhao, MD1, Peter C. Amadio, MD1, Philippe Paillard, MD1, Tatsuro Tanaka, MD1, Mark E. Zobitz, MS1, Dirk R. Larson, MS1 and Kai-Nan An, PhD1

1 Orthopedic Biomechanics Laboratory (C.Z., M.E.Z., and K.-N.A.) and Department of Orthopedics (P.C.A., P.P., T.T., and D.R.L.), Mayo Clinic, 200 First Street S.W., Rochester, MN 55905. E-mail address for P.C. Amadio: pamadio{at}mayo.edu

Investigation performed at the Orthopedic Biomechanics Laboratory, Mayo Clinic, Rochester, Minnesota

In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from the National Institute of Arthritis and Muscular and Skin Diseases, National Institutes of Health (Grant AR44391). None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: After flexor tendon repair, the strength of the repair and the resistance to digital motion are important considerations in deciding when to initiate postoperative rehabilitation. Our objective was to assess these factors in a short-term in vivo canine model of flexor tendon repair.

Methods: Forty-eight dogs were randomly allocated to four groups based on the duration of postoperative follow-up (one, three, five, or seven days). In each group, two flexor digitorum profundus tendons of one forepaw were exposed. One tendon (the repair tendon) was sharply transected and repaired with a modified Kessler suture, and the other one (the sham tendon) was simply exposed without laceration. The involved paw was immobilized until the animal was killed on the designated day. Three tendons from each dog, including the repair tendon, the sham tendon, and a control tendon from a corresponding normal digit on the contralateral side, were tested.

Results: The mean peak total digital resistance force in the repair group was lowest at five days (p < 0.01 compared with seven days; p > 0.05 compared with one and three days). The mean peak force needed to overcome the internal gliding resistance between the repaired tendon and sheath was significantly higher than that in both the sham and control groups at all time-points (p < 0.001); however, this value was also smallest at five days. There was no significant difference in suture strength at any time-point (p > 0.05).

Conclusions: When we evaluated tendon-gliding and suture strength after flexor tendon repair, the least favorable ratio of repair strength to force needed to overcome the resistance to digital motion was noted on Day 7, whereas the best combination of tendon strength and low peak resistance force was noted on Day 5.

Clinical Relevance: The results of the present study suggest that postoperative Day 5 may be the best time to begin rehabilitation, with either active or passive therapies, as the amount of tendon force necessary to initiate tendon motion is least at this time.


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