Q Suture Technique: A Suturing Technique to Reduce Gap Formation and Increase Tensile Strength in Tendon Repair

Tendons are connective tissue that attaches the muscles to bones. Damaged tendons can be repaired by stitching their cut ends using the core suturing technique. This procedure still leaves gaps between tendon ends. To reduce any remaining gaps, an additional suturing technique called Q suture is performed.

Begin by placing two incised porcine tendon stumps longitudinally next to each other. For core suturing, mark points at an appropriate distance from the cut tendon end on the anterior and lateral sides. These points help determine the path of the suture.

Insert a longitudinal suture from the cut end. Advance it toward one of the anterior marking points. Pull the suture out from this point. Reinsert it into the nearby lateral marking, making a loop. Pass the suture through the other two markings. Repeat the process with the other stump and knot the sutures to ligate two stumps.

After core suturing, insert the suture on the anterior side of one tendon stump. Loop it on the posterior side of the second stump, spanning the core suture. Withdraw the suture from anterior portion of the second stump. Tie the knots to complete one Q suture. Repeat the process on the opposite side to add the second Q suture.

The repaired tendon is ready for further applications.

To perform a tendon repair, begin by marking the anterior surface of one of the porcine tendon stems, with two points that are 10 millimeters from the cut tendon, one-fourth of the way from the left and right sides of the tendon in the medial-lateral direction. Mark each of the left and right lateral surfaces of the tendon with one point that is 8 millimeters from each cut tendon end, and locate the point in the middle of the anterior-posterior direction.

Then, use a vernier caliper to measure all of the lengths between each set of points. Using 4-0 sutures, insert a needle into the cut surface of one tendon stump from the middle point in the anterior-posterior direction, and one-fourth of the way from the left in the medial-lateral direction.

Draw a region of interest around the selected neuron, and draw a second larger region of interest around the tail that includes the first region of interest. Reinsert the needle obliquely from point three, and pass the needle transversely toward point four. Pull out the suture to create a small loop at the lateral surface of the tendon, and reinsert the needle obliquely from point two, passing the needle longitudinally toward the cut end.

Then, pull out the suture. To form a symmetrical repair, insert the needle into the cut end of the other tendon stump, and suture the other stump with the same construct. Tighten the suture with a 10% shortening of the tendon segment within the core suture, and tie the tendon ends together with three to four knots to complete the two-strand core suture.

To complete a four-strand core suture, repeat the suturing process as just demonstrated. To add Q suture, insert the same needle into the tendon anterior surface, 2 millimeters away from the joined tendon end, and withdraw the needle on the posterior surface of the tendon. Reinsert the needle into the posterior surface of the tendon, 2 millimeters away from the other side of the joined tendon end. Pull out the suture from the anterior surface of the tendon, and tie three knots to complete the first Q suture.

Then, repeat the procedure to complete the second Q suture. To add a running suture in the two-strand or four-strand core suture plus running group, use a 6-0 suture to add a running epitendinous suture of 9 to 10 stitches to the tendon ends, keeping a similar purchase of 1.5 millimeters and a depth of 1 millimeter. When all of the sutures have been placed, cover the repair of the tendon with wet gauze.