Bending and abrasion fatigue of common suture materials used in arthroscopic and open orthopedic surgery

Abstract

In orthopedic surgery, the reattachment of tendon to bone requires suture materials that have stable and durable properties to allow time for healing at the tendon-bone interface. The suture, not rigidly restrained within the anchor eyelet, is free to move during surgery and potentially after surgery with limb motion. During such movement, the suture is subjected to bending and frictional forces that can lead to fatigue-induced failure. We investigated some common contemporary commercial number-two-grade suture materials and evaluated their resistance to bending abrasion fatigue and the consequent failure. Sutures were oscillated over a stainless steel wire at low frequency under load. Number of abrasion cycles to failure, changes in suture morphology, and fatigue-failure method was recorded for each material. Suture structure had a significant effect on abrasion resistance, with braided sutures containing large numbers of fine high tenacity core filaments performing15-20 times better than other braided suture structures. Ultra high molecular weight polyethylene (UHMWPE) core filaments resisted bending abrasion failure better than other core materials due to the load spreading and abrasion resistance of these filaments. Sutures with UHMWPE cores also had high resistance to tensile failure. Limited correlation was observed between tensile strength and abrasion resistance. ß

Intertarsal Joint Stabilization in a Bateleur Eagle (Terathopius ecaudatus) Using a Novel Application of a Braided Suture and Titanium Button System

“…The orientation and positioning of the stabilization implant materials allows for distribution of tension arising from the tightened suture to the titanium button implants located at the medial aspect of the joint rather than encircling and compressing the joint. Additionally, the FiberWire suture used in this case is made up of a core of ultrahigh molecular weight polyethylene material with a braided outer layer of combined polyester and polyethylene fibers that has demonstrated greater strength, knot security, and resistance to bending abrasion failure than many other suture materials, including polyester [7, 8]. The technique performed in this case is similar to that reported for correction of stifle, hip, and shoulder joint instability in the dog [9–11] as well as for a variety of applications in humans.…”

Biomechanical evaluation of the Nice knot

“…[ 1 ] All materials used were comprised of an ultrahigh molecular weight polyethylene braid (UHMWPE) except FiberWire, which has a polyester braid surrounding a UHMWPE core. [ 10 ] It was determined that this had a definite effect on breakage within a construct, with a UHMWPE core conveying a greater resistance to abrasion — however all polybraid sutures demonstrated poor abrasion resistance. [ 10 ] This could be relevant to the outcomes of our investigations given the different knots tied will have a different number of bends required in the suture and so will wear differently.…”

“…[ 10 ] It was determined that this had a definite effect on breakage within a construct, with a UHMWPE core conveying a greater resistance to abrasion — however all polybraid sutures demonstrated poor abrasion resistance. [ 10 ] This could be relevant to the outcomes of our investigations given the different knots tied will have a different number of bends required in the suture and so will wear differently. [ 10 ] In addition, in vivo this will likely have an effect secondary to the physiological response to wear debris.…”

“…[ 10 ] This could be relevant to the outcomes of our investigations given the different knots tied will have a different number of bends required in the suture and so will wear differently. [ 10 ] In addition, in vivo this will likely have an effect secondary to the physiological response to wear debris. [ 10 ] Within this study, no other specific interactions between knot-type and material type were examined.…”

“…[ 10 ] In addition, in vivo this will likely have an effect secondary to the physiological response to wear debris. [ 10 ] Within this study, no other specific interactions between knot-type and material type were examined. The authors of this study feel that these areas require further investigation, in agreement with recently published literature.…”