A Knotless Flexor Tendon Repair Technique Using a Bidirectional Barbed Suture

Abstract

The authors demonstrate that knotless flexor tendon repair with barbed suture has equivalent strength and reduced repair-site cross-sectional area compared with traditional techniques. The smaller tendon profile may decrease gliding resistance, thus reducing the risk for postsurgical tendon rupture during rehabilitation.

A Biomechanical Comparison of Tendon Repair with a Knotless Barbed Suture and a Conventional Monofilament Suture Material: An ex-vivo Animal Experiment

“…Contrary to our findings which showed the barbed suture to be biomechanically equivalent to the conventional monofilament sutures, there are studies which have found them to be inferior and superior to the conventional sutures (9,(11)(12)(13)(14). Trocchia et al (11) reported that Kessler tendon repair done with a 2/0 barbed suture was biomechanically inferior to the repair done with a 3/0 non-absorbable braided conventional suture.…”

“…Trocchia et al (11) reported that Kessler tendon repair done with a 2/0 barbed suture was biomechanically inferior to the repair done with a 3/0 non-absorbable braided conventional suture. McClellan et al (12) investigated the ultimate tensile strengths of three different tendon repairs. In the first group, repairs were made using a 3/0 Ethibond modified Kessler 2-strand repair, in the second group a 3-0 Ethibond modified Savage repair and in the third group a unique knotless 4-0 novel barbed suture.…”

The use of bidirectional barbed suture in the treatment of a complete common calcanean tendon rupture in a dog: Long‐term clinical and ultrasonographic evaluation

“…This study also demonstrated that the three-loop pulley pattern was more effective in resisting gap formation compared to the Bunnell-Mayer pattern. 39 In contrast to the recent studies, 37,39 our case report suggests that barbed suture can be used as an effective alternative to traditional suture for repair of a common calcaneal tendon rupture. In the current case report, a modified Kessler suture technique was used rather than a three-loop pulley suture technique.…”

“…This along with other commercially available barbed suture has been successfully tested in many biomechanical human and animal tendon models. 12,[27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] In the human literature, the use of at least four specialized barbed sutures for flexor tendon repair was described in several studies between 1945 and 1968 but were not widely adopted. 27 Work by McKenzie 28 in 1967 involving barbed suture for the repair of flexor tendons in cadaveric models established early data regarding tensile strength of barbed suture, finding it comparable to more traditional techniques.…”

“…38 Similar results were demonstrated in an ex vivo study evaluating performance and resistance to gap formation of nonabsorbable, barbed, monofilament suture compared to nonabsorbable, smooth, monofilament polypropylene suture. 39 Three-loop pulley and modified Bunnell-Mayer patterns were used in transected cadaveric superficial digital flexor tendons, and the smooth polypropylene suture was consistently superior in load performance when compared to unidirectional barbed suture. This study also demonstrated that the three-loop pulley pattern was more effective in resisting gap formation compared to the Bunnell-Mayer pattern.…”