Water-Tight Knee Arthrotomy Closure: Comparison of a Novel Single Bidirectional Barbed Self-Retaining Running Suture Versus Conventional Interrupted Sutures

Abstract

Standard medial parapatellar arthrotomies of 10 cadaveric knees were closed with either conventional interrupted absorbable sutures (control group, mean of 19.4 sutures) or a single running knotless bidirectional barbed absorbable suture (experimental group). Watertightness of the arthrotomy closure was compared by simulating a tense hemarthrosis and measuring arthrotomy leakage over 3 minutes. Mean total leakage was 356 mL and 89 mL in the control and experimental groups, respectively (p ¼ 0.027). Using 8 of the 10 knees (4 closed with control sutures, 4 closed with an experimental suture), a tense hemarthrosis was again created, and iatrogenic suture rupture was performed: a proximal suture was cut at 1 minute; a distal suture was cut at 2 minutes. The impact of suture rupture was compared by measuring total arthrotomy leakage over 3 minutes. Mean total leakage was 601 mL and 174 mL in the control and experimental groups, respectively (p ¼ 0.3). In summary, using a cadaveric model, arthrotomies closed with a single bidirectional barbed running suture were statistically significantly more water-tight than those closed using a standard interrupted technique. The sample size was insufficient to determine whether the two closure techniques differed in leakage volume after suture rupture.

RETRACTED ARTICLE: Use of Barbed Sutures in Bariatric Surgery. Review of the Literature

“…Accordingly, Nett et al [15] reported the superiority of tightness in arthrotomy closure with a barbed suture compared to a non-barbed suture, finding that after the simulation of a tense hemarthrosis, the barbed suture leaked 89 ml while the non-barbed suture drained 356 ml.…”

Bacteria Adhere Less to Barbed Monofilament Than Braided Sutures in a Contaminated Wound Model

“…Barbed monofilament suture is being used more frequently as a result of its efficiency, cost savings, and improved or comparable wound closure outcomes [5, 7, 15-17, 19, 21, 23, 24, 26, 28]. The use of barbed monofilament suture for closure in a TKA has shown superiority in tightness of closure and failure analysis [16,24]. However, the barbed nature of this monofilament suture has the theoretical concern of the barbs acting as a place for bacteria to hide, resulting in higher infection rates if contaminated wounds are closed with barbed monofilament suture.…”

Is There an Advantage to Knotless Barbed Suture in TKA Wound Closure? A Randomized Trial in Simultaneous Bilateral TKAs

“…Evidence from cadaver knee studies suggests that bidirectional barbed sutures may provide a more watertight closure [6] and evidence from biomechanical testing suggests that TKAs closed with bidirectional barbed sutures are more resistant to failure than those where interrupted standard sutures have been used [12].…”