M-Tang technique

The M-Tang technique is the contemporary reference standard for primary repair of zone II flexor tendon injuries. It refines the multistrand-repair concept introduced by Savage in 1985 into a reproducible operative pathway, described by Tang JB in detail in a 2007 paper on zone II repair and reaffirmed in a 2018 review. The construct uses a four- or six-strand core suture with adequate purchase length (0.7–1 cm in each tendon end), modest tension calibrated to produce slight bunching at the repair site, locking grasps where geometry permits, and a peripheral epitendinous mattress to complete the repair. Tang's explicit 2018 position — that a controlled bulkiness at the repair site is acceptable and beneficial for resistance to gap formation under cyclic loading — reverses the earlier Strickland-era preference for the most parsimonious construct. Combined with judicious A2 or A4 venting where required and early active mobilisation, the M-Tang construct supports rerupture rates of 0–4% and good-or-excellent functional outcomes in over 80% of zone II repairs in published series.