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

Abstract

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.

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.…”

Barbed Sutures and Tendon Repair—a Review

“…Their results demonstrate a statistically significant higher load to failure for the barbed suture group as compared to the unbarbed group [18].…”

Comparison of Barbed Sutures in Porcine Flexor Tenorrhaphy

“…Tendons were preloaded to 3 N and then stretched linearly by the Instron™ machine (Model 8521; InstronCorp., Canton, MA) at a rate of 20 mm/min until failure, similar to protocols used in similar studies. 10,13,27,28 Trials were recorded using a digital video camera and a ruler was positioned next to the tendon to provide a reference of length.…”

“…23 Barbed suture tenorrhaphy theoretically allows smoother gliding under pulleys by decreasing cross-sectional area under load, better load distribution along the entire suture length, and improved tendon flow by reducing constricting forces. 10 10,11,13,14,18,19,23,27,28 but minimal data exist in comparing the barbed sutures with each other. The purpose of this study was to determine if any differences exist between conventional nonbarbed, V-Loc™, and Stratafix™ barbed suture core repairs in gap resistance or ultimate tensile strength in an established biomechanical ex vivo model of flexor tenorrhaphy.…”

“…Quill SRS™ (Angiotech Pharmaceuticals, Inc., Vancouver, BC, Canada), an absorbable unidirectional barbed polydioxane suture; and Stratafix™ (Ethicon, Johnson & Johnson, USA), a form of Quill SRS modified with proprietary needles. Most studies have compared one of the commercially available barbed sutures with conventional nonbarbed sutures 10,11,13,14,18,19,23,27,28 but minimal data exist in comparing the barbed sutures with each other. The purpose of this study was to determine if any differences exist between conventional nonbarbed, V-Loc™, and Stratafix™ barbed suture core repairs in gap resistance or ultimate tensile strength in an established biomechanical ex vivo model of flexor tenorrhaphy.…”