Technical Tips

When passing the funnel and catheter, clamp the suture at the far cut end of the catheter which should hold the tip of the funnel securely inside the lumen of the catheter – then pull on the suture and catheter to pass the tendon.
As the tendon enters the pulley, go slowly and watch the tendon enter the tunnel.

Suturing

Make sure the first pass is 1-1.2 cm from the cut end – helps to use a 1cm segment cut from a ruler to make sure. If not, the cross-lock will not hold at optimum strength.
Second pass halfway, i.e. 0.6mm to cut end.
The gliding stitch should come out the MIDDLE of the tendon end – otherwise the crimp will end up too volar.
After making the cross-lock, pull each cable VERY TIGHT so the cross lock sits flush and firm on the surface of the tendon – and NOT loose.

Passing cables through the crimp

Pass the shrink wrapped portion of the cable through the crimp so that only the metal part is within the crimp. To thread the final or fourth cable, hold the cable very near the end and an assistant may help by pulling the cables that are already in the crimp to one side. As the last cable goes through the crimp, the assistant may pull the other strands in the same direction, which pulls the final cable through, allowing it to pass.
To pass the last cable through the crimp, hold the cable very close to the end. Holding with a needle holder may be helpful.
Once again, pull EACH STRAND INDEPENDENTLY tight so the cross-lock is tight before approximating the tendon ends.
Place one 6-0 epitendinous stitch to get the exact tendon rotation for the repair.

Crimping

When placing the crimp tool, be careful not to have the posterior jaw include any tendon – try to include only the crimp —- make sure the tool is on straight and rotated exactly correct before crimping.
Be careful to not to crush any cable – only the crimp.
Leave the crimp tool on for 5-10 seconds.
Cut the cable very short on the crimp.