The effect of knot location, suture material, and suture size on the gliding resistance of flexor tendons

Momose, Toshimitsu; Amadio, Peter C.; Zhao, Chunfeng; Zobitz, Mark E.; An, Kai Nan

doi:10.1002/1097-4636(2000)53:6<806::aid-jbm23>3.0.co;2-p

Cited by 96 publications

(65 citation statements)

References 11 publications

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“…First, knots add bulk to the repair site, which increases the cross-sectional area of the tendon. If the cross-sectional area is increased, the gliding resistance through the pulley system is also increased [2,6,25]. [21] Therefore, if a robust knot is created (five throws) [34], gliding will be impeded.…”

Section: Discussionmentioning

confidence: 99%

Barbed Sutures and Tendon Repair—a Review

Shah

Rowlands

2014

Hand (New York, N,Y.)

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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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Section: Discussionmentioning

confidence: 99%

Barbed Sutures and Tendon Repair—a Review

Shah

Rowlands

2014

Hand (New York, N,Y.)

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“…There are substantial differences between these studies, including variability in the diameter of the conventional and barbed sutures used, the types of traditional repairs used, and whether human cadaveric or porcine flexor tendon models were used. Furthermore, each of the studies used a different and novel suture configuration for the knotless repair [19][20][21]23]. Because of this, it is difficult to summarize the findings of these studies.…”

Section: Discussionmentioning

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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“…There also must be minimal swelling in the suture area, and it must be strong enough to permit active movement in the early stages after suturing 11 . In contrast to this ideal, the most widely used tendon suture has a knot and also has limitations in acquiring a high tensile strength due to swelling.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical Analysis of Resorbable Barbed Suture Tenorrhaphy

Lee

Kim

Oh³

et al. 2016

J Korean Soc Surg Hand

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This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/bync/ 3.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.Purpose: To evaluate the tensile strength and repair-site profile of a technique of resorbable barbed suture tenorrhaphy. Methods: Forty-eight flexor digitorum profundus tendons were collected from the 8 adult cadavers. In the test group, the tendons were sutured using absorbent 2-0 barb knotless sutures in a 2-strand or 4-strand zig-zag pattern. In the control group, 2-0 Prolene and 3-0 polydioxanone (PDS) were used to suture the tendons using the 2-stand Modified Kessler method and the 4-strand cruciate suture method. Using a tensile force measurement machine, the breaking load (N) and the stiffness (N/mm) were measured. The types of rupture were categorized into suture breaking, knot rupture, and pullout. Results: In the comparative analysis between the absorbent 2-0 Quill (Angiotech Pharmaceuticals, Canada) suture that used the 2-strand core suture and the 3-0 PDS and 2-0 Prolene sutures, the average breaking load for the 2-0 Quill suture was 26.83±7.47 N, and 21.96±6.78 N and 17.20±4.93 N for the 2-0 Prolene and 3-0 PDS sutures. In the comparison using the 4-strand core suture, the average breaking load for the 2-0 Quill suture was 62.50±13.34 N, and 22.35±5.72 N and 18.67±4.27 N for the 2-0 prolene and 3-0 PDS sutures. The most common type of rupture were knot rupture. Conclusion: For flexor tendon sutures using the absorbent barb sutures, compared to the conventional 2-0 Prolene or 3-0 PDS sutures, absorbent barbed sutures have a higher tensile strength.

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The effect of knot location, suture material, and suture size on the gliding resistance of flexor tendons

Cited by 96 publications

References 11 publications

Barbed Sutures and Tendon Repair—a Review

Barbed Sutures and Tendon Repair—a Review

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

Biomechanical Analysis of Resorbable Barbed Suture Tenorrhaphy

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