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Use of the Taguchi Method for Biomechanical Comparison of Flexor-Tendon-Repair Techniques to Allow Immediate Active Flexion. A New Method of Analysis and Optimization of Technique to Improve the Quality of the Repair*†
GORDON SINGER, M.D., M.S.‡; EDWARD EBRAMZADEH, PH.D.§; NEIL FORD JONES, M.D.#; ROY MEALS, M.D.**, LOS ANGELES, CALIFORNIA
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Investigation performed at the University of California, Los Angeles, and the Los Angeles Orthopaedic Hospital, Los Angeles
J Bone Joint Surg Am, 1998 Oct 01;80(10):1498-1506
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Abstract

The current trend toward early active flexion after repair of the flexor tendons necessitates a stronger repair than that provided by a modified Kessler technique with use of 4-0 nylon suture. The purpose of the current study was to determine, with use of the Taguchi method of analysis, the strongest and most consistent repair of the flexor tendons.Flexor tendons were obtained from fresh-frozen hands of human cadavera. Eight flexor tendons initially were repaired with the modified Kessler technique with use of 4-0 nylon core suture and 6-0 nylon epitenon suture. A test matrix was used to analyze a total of twenty variables in sixty-four tests. These variables included eight techniques for core-suture repair, four types of core suture, two sizes of core suture, four techniques for suture of the epitenon, and two distances from the repair site for placement of the core suture. After each repair, the specimens were mounted in a servohydraulic mechanical testing machine for tension-testing to failure.The optimum combination of variables was determined, with the Taguchi method, to be an augmented Becker technique with use of 3-0 Mersilene core suture, placed 0.75 centimeter from the cut edge with volar epitenon suture. The four-strand, double modified Kessler technique provided the second strongest repair. Five tendons that had been repaired with use of the optimum combination then were tested and compared with tendons that had been repaired with the standard modified Kessler technique. With the optimum combination of variables, the strength of the repair improved from a mean (and standard deviation) of 17.2 ± 2.9 to 128 ± 5.6 newtons, and the stiffness improved from a mean of 4.6 to 16.2 newtons per millimeter.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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