This orthopaedic diagnostic image consists of a series of six fluoroscopic panels demonstrating tendon repair biomechanics. The panels are organized into a 2x3 grid comparing two surgical suturing techniques—the Bunnell repair (top row) and the Cross-lock Bunnell (bottom row)—under three progressive load conditions: No tension, Low tension, and High tension. Radiopaque stainless steel wire is used to visualize the suture patterns within the tendon segments. In the Bunnell repair, increasing tension causes the distinct, loosely arranged loops to constrict and 'cut out' through the soft tissue, leading to significant longitudinal elongation and narrowing of the suture configuration. In contrast, the Cross-lock Bunnell row demonstrates a more stable, interwoven interlocking pattern. As tension increases in the Cross-lock group, the suture maintains better structural integrity and consistent apposition with minimal 'cut out' or longitudinal distortion compared to the standard Bunnell technique. White arrows indicate the direction of the applied axial load, illustrating the mechanical failure mechanism and resistance to gap formation in tendon surgery.

This clinical photograph demonstrates a surgical simulation model used for practicing tendon repair techniques. The model utilizes white, fibrous dental rolls as an inexpensive substitute for human tendons due to their comparable size, shape, and tactile feedback when suturing. Two vertical tape strips secure a horizontal dental roll to a flat surface, simulating a cut tendon end under tension. The image specifically illustrates the placement of core and epitendon sutures. A dark, thin suture thread is visible, forming a circumferential ring around the cylinder to demonstrate an epitendon suture placed approximately 2mm from the edge. Additionally, markings or needle entry points indicate the placement of a core suture at a 10mm distance. This educational setup is designed for surgical skills training in orthopedics or plastic surgery to master complex suturing patterns, such as the Kessler or modified Bunnell techniques, without the need for animal tissue.

A multi-panel medical resource demonstrating surgical techniques for Achilles tendon repair. (A) Anatomical diagram illustrating the internal logic of a combined Krackow and Kessler suture approach. The Krackow technique shows interlocking peripheral loops, while the modified Kessler technique depicts a central core suture bridging the proximal and distal tendon segments. (B) Intraoperative clinical photograph showing a ruptured Achilles tendon being approximated. The tissue appears erythematous and frayed at the rupture site. Thin, dark non-absorbable sutures are woven through the tendon substance using the Krackow locking loop and modified Kessler techniques to align and stabilize the torn ends. (C) Clinical photograph of the completed repair reinforced with four figure-eight sutures across the dorsal aspect. These sutures create a distinct criss-cross pattern over the rupture site, providing secondary reinforcement to the primary core sutures. This educational material is designed for orthopedic surgery training, focusing on maximizing tensile strength and stability during tendon healing.

This composite educational resource consists of clinical photographs and a comparative bar chart demonstrating the biomechanical properties of different tendon repair techniques. Panel A shows a clinical photograph of a tendon repaired with a Bunnell suture pattern, displaying the characteristic ladder-like, horizontal dark blue suture passes across the pale fibrous tissue. Panel B illustrates a 5-mm gap formation between the proximal and distal tendon segments under mechanical stress, highlighting the vertical stretching of the core suture material. Panel C is a quantitative bar graph comparing 'Initial Gap Force' and '5-mm Gap Force' (measured in Newtons) across four surgical techniques: standard Bunnell, Tensioned Bunnell, Cross-lock Bunnell, and Tensioned Cross-lock Bunnell. The graph indicates that pretensioning and cross-locking configurations significantly increase the resistance to gap formation compared to the standard Bunnell technique. This content is designed for orthopaedic surgical education, focusing on tendon repair strength, suture morphology, and biomechanical failure thresholds.

A multi-panel educational figure demonstrating biomechanical testing of porcine tendon repair techniques. Panels A-C provide close-up clinical photographs of three specific suture configurations: (A) Modified Kessler (MK) showing a classic boxed core suture with peritendinous reinforcement, (B) Interlock Suture (IS) exhibiting a continuous interlocking pattern for increased grip, and (C) Modified Kessler-Loop Lock (MKL) featuring boxed sutures with additional locking loops. Panel D displays the experimental setup with a repaired tendon secured vertically between the pneumatic grips of a mechanical testing machine (Instron model). Panel E shows the clinical manifestation of mechanical failure, characterized by a visible 2-mm gap formation and fraying of tendon fibers at the repair site under tension. Panel F is a line graph illustrating a typical load-deformation curve, plotting tensile Load (N) against Extension (mm), with a designated triangle marking the 'Ultimate Failure Load' at approximately 75N. This figure is used in orthopedic research and surgical training to compare the tensile strength and failure modes of different flexor tendon repair strategies.

Educational panel illustrating a specialized pull-out suture technique for flexor digitorum profundus (FDP) tendon repair in the finger. A-C: Anatomical diagrams in lateral and frontal views. (A) Shows a modified Kessler-type suture applied to tendon stumps with a 1.4 mm diameter suture passer introduced through the digital pulp into the osteofibrous tunnel. (B) Demonstrates the suture passer guiding mononylon threads distally toward the fingertip. (C) Illustrates the final pull-out fixation where the suture ends are secured over a protective silicone button at the digital pulp tip, alongside an epitendinous suture at the repair site. This configuration shifts traction forces away from the primary repair zone. (D) Intraoperative clinical photograph showing the surgical field with the suture passer exiting the distal pulp and threads being managed through an open palmar-digital incision. The content demonstrates hand surgery techniques for Zone II tendon injuries, focusing on minimizing gap formation and allowing early active motion.

A multi-panel medical resource demonstrating surgical techniques for Achilles tendon repair. (A) Anatomical diagram illustrating the internal logic of a combined Krackow and Kessler suture approach. The Krackow technique shows interlocking peripheral loops, while the modified Kessler technique depicts a central core suture bridging the proximal and distal tendon segments. (B) Intraoperative clinical photograph showing a ruptured Achilles tendon being approximated. The tissue appears erythematous and frayed at the rupture site. Thin, dark non-absorbable sutures are woven through the tendon substance using the Krackow locking loop and modified Kessler techniques to align and stabilize the torn ends. (C) Clinical photograph of the completed repair reinforced with four figure-eight sutures across the dorsal aspect. These sutures create a distinct criss-cross pattern over the rupture site, providing secondary reinforcement to the primary core sutures. This educational material is designed for orthopedic surgery training, focusing on maximizing tensile strength and stability during tendon healing.

This orthopaedic diagnostic image consists of a series of six fluoroscopic panels demonstrating tendon repair biomechanics. The panels are organized into a 2x3 grid comparing two surgical suturing techniques—the Bunnell repair (top row) and the Cross-lock Bunnell (bottom row)—under three progressive load conditions: No tension, Low tension, and High tension. Radiopaque stainless steel wire is used to visualize the suture patterns within the tendon segments. In the Bunnell repair, increasing tension causes the distinct, loosely arranged loops to constrict and 'cut out' through the soft tissue, leading to significant longitudinal elongation and narrowing of the suture configuration. In contrast, the Cross-lock Bunnell row demonstrates a more stable, interwoven interlocking pattern. As tension increases in the Cross-lock group, the suture maintains better structural integrity and consistent apposition with minimal 'cut out' or longitudinal distortion compared to the standard Bunnell technique. White arrows indicate the direction of the applied axial load, illustrating the mechanical failure mechanism and resistance to gap formation in tendon surgery.

This clinical photograph demonstrates a surgical simulation model used for practicing tendon repair techniques. The model utilizes white, fibrous dental rolls as an inexpensive substitute for human tendons due to their comparable size, shape, and tactile feedback when suturing. Two vertical tape strips secure a horizontal dental roll to a flat surface, simulating a cut tendon end under tension. The image specifically illustrates the placement of core and epitendon sutures. A dark, thin suture thread is visible, forming a circumferential ring around the cylinder to demonstrate an epitendon suture placed approximately 2mm from the edge. Additionally, markings or needle entry points indicate the placement of a core suture at a 10mm distance. This educational setup is designed for surgical skills training in orthopedics or plastic surgery to master complex suturing patterns, such as the Kessler or modified Bunnell techniques, without the need for animal tissue.

This educational image displays a clinical photograph and a corresponding anatomical diagram illustrating a surgical repair technique for a bony avulsion of the flexor digitorum profundus (FDP) tendon. Panel A shows lateral and volar views of a human cadaveric distal phalanx and FDP tendon. The repair utilizes blue suture material woven through the tendon and anchored to an avulsed bone fragment. Panel B provides a sagittal and volar schematic of a novel repair method using a suture anchor. The diagram depicts a threaded anchor embedded in the distal phalanx with red suture lines following a specific path: exiting the bone, passing through the reduced avulsed fragment, and securing the tendon using a Bunnell crisscross suture technique. Key educational concepts include the 'deadman theory' of anchor placement at a 45-degree angle and the use of tension banding principles to achieve stable interosseous attachment. This material is designed for orthopedic and hand surgery education, demonstrating techniques for managing Jersey Finger or similar distal phalanx tendon injuries.

This orthopaedic illustration depicts the Bunnell suture repair technique used for triceps tendon ruptures. Image A is a detailed anatomical drawing showing the triceps muscle belly in red, distal triceps tendon, and a semitendinosus allograft. The allograft is looped around the triceps tendon and secured to the distal bone (olecranon) using the Bunnell technique. The repair features non-absorbable sutures woven in a characteristic criss-cross, figure-of-eight pattern (whipstitch) through the tendon substance to provide high tensile strength and minimize suture pullout. Image B provides a simplified schematic diagram of the same Bunnell stitch configuration, highlighting the 'X' shaped intersections of the suture and the horizontal locking components that bridge the gap between two ends of a ruptured tendon or a tendon-bone interface. This visual material is intended for orthopedic education regarding surgical management of tendon injuries and biomechanical stability in ligamentous repair.

This composite image includes a percutaneous Achilles tendon repair schematic and a clinical follow-up photograph. Panel (a) presents a nine-step procedural diagram of the Ma and Griffith technique for acute Achilles tendon rupture. The line drawings illustrate the proximal and distal tendon stumps within the lower leg silhouette. The sequence details the percutaneous passage of sutures through the skin and tendon in a modified Bunnell-type weave, progressing from initial needle insertion (steps 1-3) to pulling the suture ends to approximate the tendon gap (steps 4-6) and final anchoring (steps 7-9). Panel (b) is a posterior clinical photograph of a patient’s right lower leg and ankle 90 days post-surgery. The image demonstrates a well-healed surgical site with minimal scarring, preserved calf contour, and a stable weight-bearing neutral foot position. The clinical focus is on minimally invasive orthopedic surgical techniques and the anatomical restoration of the gastroc-soleus complex.