Abrasiveness of high-strength sutures used in rotator cuff surgery: are they all the same?

Williams, Johnathan F.; Patel, Shaan; Baker, Dawn; Schwertz, Joseph M.; McGwin, Gerald; Ponce, Brent A.

doi:10.1016/j.jse.2015.07.018

Cited by 25 publications

(13 citation statements)

References 25 publications

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“…Damage at the tendon-suture interface following the cyclic loading phase was caused by the suture material cutting though the tendon substance (termed "cheese wiring"). [10][11][12] This was observed principally in the FiberWire containing constructs ( Table 2).…”

Section: Resultsmentioning

confidence: 99%

“…This is consistent with studies which demonstrate more abrasive properties in FiberWire. 10,11 Neither Krackow version demonstrated as much displacement as the FiberLoop but both had lower load to failure strengths than both FiberLoop and SpeedTrap and were clearly the most time consuming techniques to create.…”

Section: Discussionmentioning

confidence: 99%

“…This may reflect the abrasive property of FiberWire previously described in the literature. 10,11 The Krackow stitches are the gold standard in soft tissue fixation and were used as the control constructs. Evaluating the displacements between 100 cycles and 500 cycles showed that both Krackow stitches showed the least amount of change after 100 cycles.…”

Section: Discussionmentioning

confidence: 99%

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A Biomechanical Comparison of Six Suture Configurations for Soft Tissue–Based Graft Traction and Fixation

Barber

Howard

Piccirillo

et al. 2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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The purpose of this study was to compare 6 different graft fixation techniques to determine the preparation speed, fixation security, biomechanical strength, and resultant tissue trauma. Methods: Six different techniques (10 samples each): #2 OrthoCord Krackow stitch, #2 FiberWire Krackow stitch, SpeedTrap, WhipKnot, Loop-in-loop stitch were created in the distal 3 cm of 9 cm bovine flexor tendons. The proximal 3 cm tendon segment was clamped in a testing machine and the distal suture ends secured by pneumatic grips. 3 preload cycles (10N-100N) and 50N static load was followed by 500 cycles (50N-200N) and then loaded to failure. Graft preparation times, 100 and 500 cycle displacement, maximum failure load, stiffness, and failure mode were recorded. Results: Representative graft preparation times were: OrthoCord Krackow (247s), FiberWire Krackow (401s), FiberLoop (177s), SpeedTrap (42s), WhipKnot (39s), Loopin-loop (45s). No WhipKnots survived cyclic loading. 100 cycle displacements were: OrthoCord Krackow (11.5 AE 3.9 mm), FiberWire Krackow (8.9 AE 1.2 mm), FiberLoop (14.2 AE 6.1 mm), SpeedTrap (8.8 AE 2.5 mm), Loop-in-loop (10.4 AE 2.9 mm). FiberLoop displaced significantly more than all others (P ¼ .016). Maximum failure loads were: OrthoCord Krackow (364 AE 24N), FiberWire Krackow (375 AE 45N), FiberLoop (413 AE 95N), SpeedTrap (437 AE 65N), WhipKnot (153 AE 42N), Loop-in-loop (329 AE 112N). The most common failure mode was suture breaking. FiberWire containing constructs (Krackow and FiberLoop) shredded or cut through ("cheese wiring") prior to failure in a majority. Conclusions: SpeedTrap, WhipKnot and Loop-in-loop were quickest to create (under 1 minute). The Krackow, SpeedTrap, WhipKnot, and Loop-in-Loop did not damage the tendon during cyclic loading. SpeedTrap and Krackow had the least displacement. FiberLoop displaced more than all other groups (P ¼ .016). No WhipKnot completed cyclic loading. The SpeedTrap (437N) and FiberLoop (413N) had the highest ultimate strength. Clinical Relevance: While the SpeedTrap and FiberLoop are the strongest techniques, the FiberLoop shreds the tendon, displaced the most, and took longer to create. Based on these results, the SpeedTrap demonstrates the best overall performance.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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A Biomechanical Comparison of Six Suture Configurations for Soft Tissue–Based Graft Traction and Fixation

Barber

Howard

Piccirillo

et al. 2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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“…The commonest mode of failure is from 'cheese wiring' of the suture through the repaired tendon. Whilst this has been reduced in biomechanical studies by using braided sutures to increase the coefficient of friction [16,19,26], the native tendon remains the vulnerable link. Currently, sutures used in rotator cuff repair are inert structures of synthetic material.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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Background Rotator cuff tendon repair in humans is a commonly performed procedure aimed at restoring the tendon-bone interface. Despite significant innovation of surgical techniques and suture anchor implants, only 60% of repairs heal successfully. One strategy to enhance repair is the use of bioactive sutures that provide the native tendon with biophysical cues for healing. We investigated the tissue response to a multifilament electrospun polydioxanone (PDO) suture in a sheep tendon injury model characterised by a natural history of failure of healing. Methodology and results Eight skeletally mature English Mule sheep underwent repair with electrospun sutures. Monofilament sutures were used as a control. Three months after surgery, all tendon repairs healed, without systemic features of inflammation, signs of tumour or infection at necropsy. A mild local inflammatory reaction was seen. On histology the electrospun sutures were densely infiltrated with predominantly tendon fibroblast-like cells. In comparison, no cellular infiltration was observed in the control suture. Neovascularisation was observed within the electrospun suture, whilst none was seen in the control. Foreign body giant cells were rarely seen with either sutures. Conclusion This study demonstrates that a tissue response can be induced in tendon with a multifilament electrospun suture with no safety concerns.

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“…In this technique, we used Ultrabraid (Smith & Nephew), which is an ultrahigh-molecular-weight polyethylene polymer coated with silicone, which has a low abrasive property. 13 Screw fixation or even the bioabsorbable pin or K-wire fixation needs to have a larger osteochondral fragment with larger bone attached to it to ensure no comminution of the fragment and adequate fixation. Suture fixation does not create holes in the osteochondral fragment and does not need thick bony attachment on the fragment for adequate compression and fixation.…”

Section: Discussionmentioning

confidence: 99%

Crossing Suture Technique for the Osteochondral Fractures Repair of Patella

Al-Fayyadh

Kho

et al. 2017

Arthroscopy Techniques

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Osteochondral fracture of the patella is a common concomitant injury of the knee, especially in lateral patellar instability, and the importance of early stable fixation with minimal complication and early mobilization should be emphasized. Screws and Kirschner wires both absorbable and nonabsorbable have been the common mode of fixation of these fractures. Nevertheless, these fixation techniques require larger osteochondral fragments and are associated with cartilage abrasion, hardware prominence, synovitis, and foreign body reaction. In contrast, suture fixation can adequately stabilize smaller osteochondral fragments without comminution and prevent some of the possible complications of other techniques of fixation. We created 4 holes in a rectangular pattern on the patella oriented perpendicular to its anteroposterior surface. We used readily available, and affordable, no. 2 Ultrabraid sutures inserted into the holes and looped around the osteochondral fragment, compressing it to the patella. The technique is very simple and is relatively easy to learn. It provides secure fixation and allows early mobilization. And it spares the knee from subsequent surgical procedure for removal of metallic implants.

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Abrasiveness of high-strength sutures used in rotator cuff surgery: are they all the same?

Cited by 25 publications

References 25 publications

A Biomechanical Comparison of Six Suture Configurations for Soft Tissue–Based Graft Traction and Fixation

A Biomechanical Comparison of Six Suture Configurations for Soft Tissue–Based Graft Traction and Fixation

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

Crossing Suture Technique for the Osteochondral Fractures Repair of Patella

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