A 4-core intra-osseous flexor tendon repair for trauma and distal 2nd stage tendon reconstruction

Published Date: 17th January 2026

Publication Authors: Lynch. J, Lonsdale. H, McArthur. P

Abstract
When performing a 2nd stage tendon reconstruction or a distal zone 1 tendon laceration repair it is necessary to repair tendon directly to bone. This can be done using many techniques including a bone anchor, button or horizontal intraosseous repair. Bony anchors are costly and are often oversized for little fingers and paediatric cases. Button techniques are complicated by incidences of pressure necrosis, infections and nail bed scarring. Horizontal intraosseous repairs were first published in 1984 by Vercimak et al.1 and others have innovated alternative methods.2 In a standard tendon laceration where there is sufficient tendon proximal and distal, it is accepted that increasing the number of core sutures from 2 to 4 core increases the strength of the repair and reduces gapping,3 however the above techniques for intraosseous repair typically involve 2 core sutures. Harenberg et al.4 described their 4-core intraosseous repair and proved it was stronger than the 2-core transverse intraosseous loop technique,5 however this repair requires two looped sutures, which are not always readily available. Below we detail our technique which requires one round bodied needle with a single strand suture, our preference is 3–0 Prolene for adults and 4–0 Prolene for small children.

Lynch, J; Lonsdale, H; Riemen, AHK; McArthur, P. (2026). A 4-core intra-osseous flexor tendon repair for trauma and distal 2nd stage tendon reconstruction. Journal of plastic, reconstructive & aesthetic surgery : JPRAS. 114(.), pp.144-146. [Online]. Available at: https://doi.org/10.1016/j.bjps.2026.01.015 [Accessed 5 February 2026]