A Knotless Flexor Tendon Repair Technique Using a Bidirectional Barbed Suture

Introduction Traumatic tendon lacerations are a common problem encountered by hand surgeons worldwide. Although the use of barbed suture to repair tendon lacerations has gained theoretical popularity in recent years, there is little information available regarding the safety, efficacy, longevity, or complications encountered when used in tenorraphy. In this study, we review the available literature on the use of barbed suture in tendon repair. Methods Studies conducted between 1980 and 2014 were identified using several databases, including EMBASE, SCOPUS, MEDLINE, and Web of Science. Keywords used to search for appropriate studies included the following: barbed, v loc, quill, tendon, tendon injuries, suture, tenorraphy, injury, and laceration, in various combinations. Results Our initial literature search identified 47 articles, and 8 were deemed appropriate for review after applying our exclusion criteria. The data from each of the articles is reviewed for the following major categories:1. Maximum load to failure 2. Mode of failure 3. Load to 2-mm gap 4. Change in cross-sectional area 5. Type of repair Conclusions Barbed suture tenorraphy has a myriad of theoretical advantages, supported by varying ex vivo studies, as compared to traditional techniques. However, due to the nonuniformity in current studies and the lack of available data in a live model, we are unable to argue for or against barbed suture tenorraphy. We believe our review provides the most in-depth analysis of barbed suture tenorraphy to date, illuminates the potential advantages of using barbed sutures, and highlights the need for further investigation into this technique.

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“…However, there were no significant differences between the barbed suture repair and the Savage repair [21].…”

Section: Positive Resultsmentioning

confidence: 69%

“…McClellan et al found that the change in tendon size with the knotless technique was significantly less than with the Savage and Kessler techniques [21].…”

Section: Change In Cross-sectional Areamentioning

confidence: 99%

Barbed Sutures and Tendon Repair—a Review

Shah

Rowlands

2014

Hand (New York, N,Y.)

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“…With this configuration, the barbs resist pull-out in one direction, and the locked loop prevents pull-out in the other direction. It should be noted that barbed suture is inherently weaker than non-barbed suture of the same diameter, and the tensile strength of barbed sutures is generally comparable to that of non-barbed suture one or two sizes smaller [19].…”

Section: Discussionmentioning

confidence: 99%

“…Because of the problems associated with knots, combined with advances in barbed suture technology, knotless tendon repair using barbed suture has been re-examined in a number of recent studies with mixed results [19][20][21][22][23]. One possible advantage of a knotless repair that has not been examined is the potential to use a suture of substantially larger diameter than would be possible in a traditional repair due to the excessively bulky knots that would be created.…”

Section: Introductionmentioning

confidence: 99%

Biomechanical Analysis of Knotless Flexor Tendon Repair Using Large-Diameter Unidirection Barbed Suture

Lin

Lakhiani

Lee

et al. 2013

Hand (New York, N,Y.)

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Purpose In traditional flexor tendon repairs, suture knots can be sites of weakness, impair tendon healing, stimulate an inflammatory response, and increase the bulk of the tendon repair. Because of this, there has been an increased interest in knotless flexor tendon repair using barbed suture. Since knots are not required, it may be possible to increase the strength of the tendon repair by using a large-diameter barbed suture. The purpose of this study was to biomechanically compare a traditional four-strand tendon repair using 3-0 braided polyester with a similar knotless four-strand tendon repair using 0 unidirectional barbed suture. Methods Twenty-two matched cadaveric flexor digitorum profundus tendons were lacerated and assigned to repair by a four-strand modified Kirchmayr-Kessler technique using 3-0 braided polyester (n=11) or knotless four-strand modified Kirchmayr-Kessler repair using 0 unidirectional barbed suture (n=11). Repaired tendons were linearly distracted to failure at 20 mm/min after 1 N preload. Maximum load and load at 2-mm gap formation were recorded. Maximum load and load at 2-mm gap formation were compared with the Student's t test, and p values≤0.05 were considered significant. Results The mean maximum load of the barbed, knotless suture repair was higher than that of the traditional repair (52 vs. 42 N). There was no difference between the two groups in the mean load required to produce a 2-mm gap. Conclusions The four-strand knotless tendon repairs using a large-diameter unidirectional barbed suture were stronger than the traditional four-strand repairs using 3-0 braided polyester, and had similar 2-mm gap resistance.

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“…Although locking loops prevent sutures from pulling, they are often associated with suture breakage and tendon rupture due to pulling of the suture at the sutured site [329]. Given that knots adversely affect gliding and locking configurations negatively impact on vascularity, barbed sutures have gained more attention as they ensure equal distribution of load throughout the intratendinous suture length [330][331][332][333][334]. Despite the significant work in the field, there is still no gold standard.…”

Section: Sutures and Screwsmentioning

confidence: 99%