{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T19:15:20Z","timestamp":1777662920270,"version":"3.51.4"},"reference-count":32,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,2,15]],"date-time":"2026-02-15T00:00:00Z","timestamp":1771113600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Hand (New York, N,Y.)"],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Flexor tendon injuries remain a challenge for hand surgeons. The constraints of the pulley system with the need for a strong repair require a delicate balance. Suture repair has been the gold standard. The 4-strand locked cruciate stitch is the technique of choice for many. This can be laborious and technically difficult. Tendon stapler devices (TSDs) aim to provide fast, strong, low-profile repairs. Industry data have shown stronger TSD repairs compared with suture repair techniques. We aim to further explore the relative strengths of TSD and 4-strand locked cruciate repairs in cadavers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Twenty-four flexor tendons were used for 12 suture repairs and 12 TSD repairs. Four-strand locked cruciate repairs used 3-0 braided composite suture. The TSD repairs used CoNextions devices. Specimens were analyzed on a uniaxial load frame and distracted at 0.5 mm\/s. Tension was recorded at 100 Hz. A camera system measured reference point positions at 10 Hz. Maximum tension and tension at 2-mm gap formation were recorded. Independent t-tests were used to compare groups, with significance noted by P &lt; .05.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Load to failure for the staple group and suture group were 70.6 \u00b1 20.5 N and 49.9 \u00b1 14.1 N, respectively. Load to 2-mm gap for the staple group and the suture group were 57.5 \u00b1 21.1 N and 38.6 \u00b1 13.7 N, respectively. Mean load to failure and load to 2-mm gap were significantly greater in the TSD group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>In this study, TSD repairs were stronger than the 4-strand locked cruciate suture repair. Further clinical studies and cost analyses are necessary to support their widespread use.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15589447251415390","type":"journal-article","created":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T06:02:58Z","timestamp":1771221778000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Tendon Stapler Device Versus Traditional Suture Repair for Flexor Tendon Injuries: A Biomechanical Comparison"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5028-7319","authenticated-orcid":false,"given":"Richard W.","family":"McKinney","sequence":"first","affiliation":[{"name":"Allegheny Health Network, Pittsburgh, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1970-4350","authenticated-orcid":false,"given":"Anna","family":"Barclay","sequence":"additional","affiliation":[{"name":"Allegheny Health Network, Pittsburgh, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacob","family":"Sneddon","sequence":"additional","affiliation":[{"name":"Allegheny Health Network, Pittsburgh, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick J.","family":"Schimoler","sequence":"additional","affiliation":[{"name":"Allegheny Health Network, Pittsburgh, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Kharlamov","sequence":"additional","affiliation":[{"name":"Allegheny Health Network, Pittsburgh, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Boyle","family":"Cheng","sequence":"additional","affiliation":[{"name":"Allegheny Health Network, Pittsburgh, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Tang","sequence":"additional","affiliation":[{"name":"Allegheny Health Network, Pittsburgh, PA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,2,15]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.4055\/cios.2014.6.2.196"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.4081\/or.2015.6125"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2014.06.005"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2019.02.010"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2021.08.033"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.32098\/mltj.03.2013.16"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcot.2020.05.038"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2014.06.025"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2006.11.009"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2010.11.029"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2008.07.009"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11552-014-9728-5"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.H.00927"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jht.2011.06.005"},{"issue":"11","key":"e_1_3_2_16_2","article-title":"Eight-strand cross-locked cruciate flexor tendon repair using double-stranded suture: a description of the surgical technique","volume":"4","author":"Watanabe K","year":"2016","unstructured":"Watanabe K, Ota H, Sasaki H. Eight-strand cross-locked cruciate flexor tendon repair using double-stranded suture: a description of the surgical technique. Plast Reconstr Surg Glob Open. 2016;4(11):e1048.","journal-title":"Plast Reconstr Surg Glob Open"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1053\/jhsu.1999.0295"},{"issue":"2","key":"e_1_3_2_18_2","article-title":"Getting better results in flexor tendon surgery and therapy","volume":"9","author":"Ayhan E","year":"2021","unstructured":"Ayhan E, Tuna Z, Oksuz C. Getting better results in flexor tendon surgery and therapy. Plast Reconstr Surg Glob Open. 2021;9(2):e3432.","journal-title":"Plast Reconstr Surg Glob Open"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-199907000-00010"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1002\/jor.22806"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.20.01253"},{"key":"e_1_3_2_22_2","first-page":"37","article-title":"A device for zone-II flexor tendon repair: surgical technique","volume":"88","author":"Su B","year":"2006","unstructured":"Su B, Solomons M, Barrow A, et al. A device for zone-II flexor tendon repair: surgical technique. J Bone Joint Surg Am. 2006;88(suppl 1, pt 1):37-49.","journal-title":"J Bone Joint Surg Am"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10195-008-0016-4"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2006.10.004"},{"key":"e_1_3_2_25_2","unstructured":"Biomechanical comparison of repair strength of CoNextions\u00ae TR tendon repair system and suture in digital flexor tendons. CoNextions Research & Development. Accessed January 6 2026. https:\/\/www.conextionsmed.com\/papers\/biomechanical-comparison-of-repair-strength\/"},{"key":"e_1_3_2_26_2","unstructured":"Repair size and glide forces for digital flexor tendons repaired with the CoNextions TRTM tendon repair system and suture. CoNextions Research & Development. Accessed January 6 2026. https:\/\/www.conextionsmed.com\/app\/uploads\/2022\/07\/CoNextions-TR-Zone-4-Glide-White-Paper.pdf"},{"key":"e_1_3_2_27_2","unstructured":"Repair size and glide forces for Zone 2 flexor digitorum profundus tendons repaired with the CoNextions TR\u00ae tendon repair system and suture. CoNextions Research & Development. Accessed January 6 2026. https:\/\/www.conextionsmed.com\/app\/uploads\/2022\/07\/CoNextions-TR-Zone-2-Glide-White-Paper.pdf"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000011102"},{"key":"e_1_3_2_29_2","volume-title":"Presented at: 39th Annual Adrian E. Flatt Residents and Fellows Conference","author":"Reed ER","year":"2021","unstructured":"Reed ER, Hendrycks R, Graham EM, et al. Tendon repairs at the wrist utilizing a novel tendon stapler device: an efficiency and biomechanical study across different experience levels. Presented at: 39th Annual Adrian E. Flatt Residents and Fellows Conference; 2021 September 30-October 2; San Francisco, CA."},{"key":"e_1_3_2_30_2","article-title":"Pivotal, randomized, controlled trial to evaluate the safety and effectiveness of the CoNextions TR tendon repair system for Zone 2 flexor tendon repair (TRFDP1 Trial)","author":"Solomons M","year":"2021","unstructured":"Solomons M, Rocher A, Ikram A, et al. Pivotal, randomized, controlled trial to evaluate the safety and effectiveness of the CoNextions TR tendon repair system for Zone 2 flexor tendon repair (TRFDP1 Trial). 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