Evaluation of High-Strength Orthopedic Sutures: A Head-to-Head Comparison

Abstract

The goal of this study was to determine whether a difference in cycles to failure or mode of failure would be observed among specimens of 3 high-strength suture materials, and whether different suture configurations would affect knot security. Ten representative specimens of Ethibond (Ethicon, Inc, Somerville, New Jersey), FiberWire (Arthrex, Inc, Naples, Florida), MaxBraid (Biomet, Inc, Warsaw, Indiana), and Orthocord (DePuy Orthopaedics, Warsaw, Indiana) were tied in 6 different knot configurations commonly used in orthopedic procedures. Each specimen was cyclically loaded between 9 and 180 N at a rate of 1 Hz until the specimen failed or reached a maximum of 3500 cycles. Each suture material was subjected to tensile loading until failure at a rate of 1.25 mm/s. The 3 most secure knots all included the 3 reverse half-hitch on alternating posts (3-RHAP) configuration. All specimens tied with these 3 knot types failed by suture rupture. All knots using the overhand with 3 of the same half-hitches on the same post (O-3SHSP) configuration failed by knot slippage regardless of suture material. When the 3 strongest knots were combined, FiberWire resisted a significantly greater number of fatigue cycles than Orthocord or MaxBraid. In the single load to failure tests, Orthocord, FiberWire, and MaxBraid all had significantly higher ultimate strength than Ethibond. Knots using the 3-RHAP configuration provide security superior to that of those without this configuration. All 3 high-strength sutures tested outperformed Ethibond in single load to failure testing, with FiberWire resisting the greatest number of cycles. Postoperative strength and reliability of a soft tissue repair is inherently dependent on the properties of the suture materials used.

Biomechanical Comparison of Interference Screw and Cortical Button With Screw Hybrid Technique for Distal Biceps Brachii Tendon Repair

“…Although literature is sparse on the significance of the difference between suture materials, this variable has provided conflicting results in studies looking at cortical button-only repairs. 34,35 For instance, when the smaller-diameter suture was used, a dramatically lower mean failure load (259 N and 274 N) resulted compared with studies that used the larger-diameter suture (584 N and 439 N). 22,23,31,33 In addition, the current study adopted the tension rate of 4 mm/s as opposed to 120 mm/s.…”

Histological evaluation of cellular response to a multifilament electrospun suture for tendon repair

“…This evolution in surgical techniques and suture anchor technology has been accompanied by innovation in sutures used in rotator cuff repair. Generally, sutures used in rotator cuff repair are nonabsorbable, braided, and much stronger than the native tendon [14,15]. Recent innovations include suture tape, which has a wider surface area to better compress the tendon to the bony footprint [16].…”

Failure of Primary Distal Biceps Repair After Cortical Button Fixation With Whipstitch Technique: A Root Cause Analysis

“…Notably, FiberLoop, a continuous loop of FiberWire® suture (Arthrex, Inc., Naples, Florida) made of a multi-strand long-chain ultra-high molecular weight polyethylene (UHMWPE), has the highest stiffness compared to other synthetic suture materials. The high-tensile strength of FiberWire, although minimizes suture breakage, is responsible for its tendon cheese-wiring behavior during cyclic loading or sudden eccentric loading, resulting in suture fixation failure [13,14].…”