A Systematic Review of 2-Strand Versus Multistrand Core Suture Techniques and Functional Outcome After Digital Flexor Tendon Repair

Purpose To determine published evidence to evaluate the hypothesis that multistrand techniques result in a poorer outcome than 2-strand techniques for digital flexor tendon repairs. Methods A systematic review was undertaken to compare outcomes and rupture rates between 2-strand and multistrand core sutures in digital flexor zones 2 to 5. Outcome was measured by the American Society for Surgery of the Hand criteria, original or modified Strickland criteria, or Buck-Gramcko criteria. Results A total of 1,878 patients (2,585 digits; 3,749 tendons) were included from the selected studies. Thirty-three studies reported 2-strand repairs and 15 reported multistrand repairs. Of the total tendon injuries, 59% were flexor digitorum profundus, 38% were flexor digitorum superficialis, and 2% were flexor pollicis longus. The pooled rupture rate was 3.9 per 100 digits. No significant difference was detected between 2-strand and multistrand repairs for outcomes by all measures or rupture rate. Conclusions Because of the wide variation in reporting of outcomes and study design on which this analysis was based, we cannot definitively confirm our hypothesis. We present the standards for outcomes as well as rupture rate for digital flexor tendon repair. (Copyright (C) 2014 by the American Society for Surgery of the Hand. All rights reserved.)