Comparison of One- and Two-knot Techniques in Eight-Strand Flexor Tendon Repair Using Looped Sutures: A… | ScholarDeck

Paper

Comparison of One- and Two-knot Techniques in Eight-Strand Flexor Tendon Repair Using Looped Sutures: A Biomechanical Study in a Porcine Model.

New research · Orthopedics

The Journal of hand surgery · 3w

Animal / preclinicalThe Journal of hand surgery· Jun 2026

Comparison of One- and Two-knot Techniques in Eight-Strand Flexor Tendon Repair Using Looped Sutures: A Biomechanical Study in a Porcine Model.

Hideomi Takami, Hideyuki Ota, Satoshi Niwa … Kazuki Uchibori

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Hand & WristAnimal / preclinicalQ1IF 2.1

One-knot tendon repairs resisted gapping better than two-knot repairs

Comparison of One- and Two-knot Techniques in Eight-Strand Flexor Tendon Repair Using Looped Sutures: A Biomechanical Study in a Porcine Model.

Hideomi Takami … Kazuki Uchibori

The Journal of hand surgery · Jun 2026 · Q1 in Orthopedics

Purpose

This study aimed to compare the biomechanical properties of one-knot and two-knot configurations in eight-strand flexor tendon repair using looped sutures.

Methods

Sixteen fresh porcine Achilles tendons were transected and randomly assigned to one-knot or two-knot repair groups (n = 8 per group).

n = 8

Results

20.4

± 7.5 N vs 10.3 ± 3.8 N

one-knot repairs resisted almost twice the force before gapping

n = 8

More results

Mean ultimate failure load was 100.1 ± 11.5 N in the one-knot group and 91.1 ± 13.7 N in the two-knot group, with no significant difference between them (P = .175).

Knot failure was predominant in the one-knot group (7 of 8), whereas suture breakage was the primary failure mode in the two-knot group (7 of 8).

“

Conclusion

The one-knot configuration provided superior gap resistance compared to the two-knot configuration in looped suture-based eight-strand flexor tendon repair. Both techniques achieved high ultimate failure strength.

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