Absorbable Sutures in Tendon Repair

Abstract

The risks of foreign implantation may be avoided in tendon repair by the use of absorbable sutures, for example polydioxanone. In this study, the in vivo tensile strength half-life of 4/0 polydioxanone was found to be approximately 4 weeks. Using a rabbit model, we compared polydioxanone tendon repairs with polypropylene tendon repairs. Unilateral flexor digitorum longus repairs were performed on 46 rabbits using either polydioxanone or polypropylene. Tendons were harvested at 3 days, 2 weeks and 4 weeks and the tensile breaking strengths were obtained. 30 intact rabbit flexor digitorum longus tendons and 20 freshly repaired tendons were also tested. By 4 weeks, the repair strength had increased eight-fold from approximately 20 N to 166 N. The sutures made little contribution to the overall strength of a 4-week-old repair. There was no significant difference between polydioxanone and polypropylene repairs at any stage. These results show that polydioxanone repairs were as strong as polypropylene during the first critical weeks of tendon healing.

Flexor Tenorrhaphy Using Absorbable Suture Materials

“…Compared to nonabsorbable sutures, the use of absorbable sutures may avoid problems associated with long-term foreign body implantation such as excessive fibrosis and stitch granuloma, but maintaining adequate tensile strength during the early reconstruction period remains a challenge due to their absorption into the body [3,5]. Thus, using absorbable sutures has been controversial.…”

“…Monofilament fiber PDS has been recently used for flexor tendon repairs. The results of an animal experiment reported by O'Broin [5] showed that PDS was not only flexible and strong, but also had high breaking strength and minimal foreign body reaction. PDS retained its breaking strength for 9 weeks, which is a relatively long time.…”

“…PDS retained its breaking strength for 9 weeks, which is a relatively long time. Thus, it was able to compensate for the disadvantages of absorbable sutures such as unpredictable maintenance of tensile strength [5,18,19]. Furthermore, PDS has the advantages of excellent wound support ability, less inflammatory responses caused by the decreased delivery of pathogenic bacteria, as well as minimal toxicity and easier handling.…”

“…However, O'Broin et al [5] reported that compared to the tensile strength of nonabsorbable sutures (Prolene, Ethicon), PDS sutures had higher tensile strength at the beginning of an operation and had similar tensile strength at the end of the second week; at this stage, there was no significant difference in suture strength between tendons repaired with PDS and Prolene. At 4 weeks, PDS has lost 50% of its original strength, and full tensile strength was lost at week 9.…”

“…To overcome the aforementioned disadvantages of nonabsorbable suture materials, the use of absorbable suture materials have been considered. In 1995, O'Broin et al [5] performed flexor tendon repair in an animal model using polydioxanone (PDS, Ethicon, San Angelo, TX, USA) absorbable sutures.…”