A Mechanical Evaluation of Zone II Flexor Tendon Repair Using a Knotless Barbed Suture Versus a Traditional Braided Suture

Nayak, Aniruddh N.; Nguyen, Dzi-Viet; Brabender, Robert C.; Hiro, Matthew E.; Miles, Jeremy J.; Smithson, Ian R.; Santoni, Brandon G.; Stone, Jeffery D.; Hess, Alfred V.

doi:10.1016/j.jhsa.2015.04.009

Cited by 18 publications

(14 citation statements)

References 15 publications

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“…There has been a plethora of recent in vivo and ex vivo research evaluating the efficacy of barbed suture for flexor tendon repairs. [4][5][6][7][8]11,14,19 Noted reasons to use barbed suture are the lack of knots which can reduce points of weakness in the repair, decreased bulkiness at the repair site which may obviate the need of an epitendinous suture, the ability for barbs to capture and lock tissue, and the ease of suture passage. 7,8,14,19 However, in our study, barbed suture did not reveal any of these characteristics.…”

Section: Discussionmentioning

confidence: 99%

“…Finally, advances in suture materials have provided alternative suture options, including barbed suture, which at this point has demonstrated mixed results, 1,[4][5][6][7][8]11,14,19 and stainless steel which has shown promising biomechanical strength in limited studies. 3,9 At this time, no research has studied the association of strength, time, and cost of repairs.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Comparing Biomechanical Properties, Repair Times, and Value of Common Core Flexor Tendon Repairs

Chauhan

Schimoler

Miller

et al. 2017

Hand (New York, N,Y.)

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparing Biomechanical Properties, Repair Times, and Value of Common Core Flexor Tendon Repairs

Chauhan

Schimoler

Miller

et al. 2017

Hand (New York, N,Y.)

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“…The proposed experimental approach did not achieve the anticipated gains in strength from having all barbs oriented to resist tendon distraction. 14,23 A potential explanation for the reduced strength of the experimental approach is that this repair may have provided less initial compression, or gap closure, along the repair site than the Marrero-Amadeo approach. For the experimental approach, each suture strand was passed across the repair site one time while the Marrero-Amadeo technique loops the suture to cross the repair site twice with locking loops.…”

Section: Discussionmentioning

confidence: 99%

In Vitro Comparison of Two Barbed Suture Configurations for Flexor Tendon Repair

et al. 2017

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The current study compares the strength of a previously studied technique for flexor tendon repair with barbed sutures to an experimental approach that aligns all the barbs to oppose distraction. Twelve flexor tendons from cadaveric specimens were mechanically tested following repair of simulated zone II tendon injuries. Two repair techniques utilizing barbed sutures were studied: the Marrero-Amadeo four-core barbed suture approach and the experimental configuration with all barbs on four cores opposing distraction. Maximum applied load at failure, that is, ultimate load, and 2-mm gap force were compared between the two repair techniques, both as raw values and after normalization to cross-sectional area of the intact tendon. Statistical testing was performed using -tests and Mann-Whitney -tests, where appropriate, with a significance level of 0.05. The ultimate loads, raw (58.2 N) and normalized (4.8 N/mm ), were significantly larger for the Marrero-Amadeo repair than the proposed experimental approach (35.6 N and 2.7 N/mm ; < 0.05). No significant differences were identified for 2-mm gap force. The innovation of suturing to align all barbs to oppose distraction does not improve strength of the repaired tendon. The Marrero-Amadeo technique was found to have superior strength for use in traumatic zone II flexor tendon injuries.

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“…Pretesting with loads up to 500 N was performed in order to ensure that there was no tendon slippage. The tendons were preloaded to 2 N and tested under linear distraction at an average rate of 50 mm/min to simulate the forces applied at the repair site during early active motion protocols [2,8,12]. Distraction continued until mechanical failure of the repair site, which was defined as a sudden decrease in tensile strength or a detectable gap >2 mm.…”

Section: Methodsmentioning

confidence: 99%

Barbed sutures versus conventional tenorrhaphy in flexor tendon repair: An ex vivo biomechanical analysis

et al. 2019

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Background The management of flexor tendon injuries has evolved in recent years through industrial improvements in suture materials, refinements of repair methods, and early rehabilitation protocols. However, there is no consensus on the ideal suture material and technique. This study was conducted to compare the tensile strength, repair time, and characteristics of 4-strand cruciate, modified Kessler, and 4-strand horizontal intrafiber barbed sutures for flexor tenorrhaphy with a 12-mm suture purchase length in an animal model. Methods The right third deep flexors of 60 adult Leghorn chicken feet were isolated and repaired with a 12-mm suture purchase length. The tendons were randomly assigned to three groups of equal number (n=20 each). Groups 1 and 2 received 4-strand cruciate and modified Kessler repair with conventional suture materials, respectively. A 4-strand horizontal intrafiber barbed suture technique was used in group 3. The repaired tendons were biomechanically tested for tensile strength, 2-mm gap resistance, and mode of failure. Repair times were also recorded. Results The maximum tensile strength until failure was 44.6±4.3 N in group 1, 35.7±5.2 N in group 2, and 56.7±17.3 N in group 3. The barbed sutures were superior to the other sutures in terms of the load needed for 2-mm gap formation (P<0.05). Furthermore, the barbed sutures showed the shortest repair time (P<0.05). Conclusions This study found that 4-strand horizontal intrafiber barbed suture repair with a 12-mm purchase length in a chicken flexor tendon injury model showed promising biomechanical properties and took less time to perform than other options.

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A Mechanical Evaluation of Zone II Flexor Tendon Repair Using a Knotless Barbed Suture Versus a Traditional Braided Suture

Cited by 18 publications

References 15 publications

Comparing Biomechanical Properties, Repair Times, and Value of Common Core Flexor Tendon Repairs

Comparing Biomechanical Properties, Repair Times, and Value of Common Core Flexor Tendon Repairs

In Vitro Comparison of Two Barbed Suture Configurations for Flexor Tendon Repair

Barbed sutures versus conventional tenorrhaphy in flexor tendon repair: An ex vivo biomechanical analysis

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