Comparing 3 Suture Techniques After Muscle Laceration Repair

Abstract

Background: Skeletal muscle lacerations are a relatively common injury. Compared with nonrepaired lacerations, surgically repaired muscle lacerations regenerate faster, develop less scar tissue, have a higher return to baseline strength, and have lower incidence of hematomas. Despite the benefits of repair, the optimal repair technique is still unknown. The purpose of this study was to examine the biomechanical properties of common muscle repair techniques to determine the optimal repair. Methods: Forty-two fusiform porcine muscle specimens were dissected and used for this study. Three suture techniques were used for comparative analysis: Figure-eight, Mason Allen, and Perimeter. Each muscle was transected and then repaired using one of the 3 techniques. Fourteen muscle-tendon specimens were prepared for each group and tested for tensile failure using a material testing system. Biomechanical properties, including peak failure point and stiffness, were compared for differences between the suture groups by 1-way analysis of variance. The average time per repair technique was also recorded. Results: The Perimeter technique showed a statistically significant higher peak failure point than the Mason Allen technique (P = .03). Both the Figure-eight (P = .047) and Perimeter techniques (P < .001) were significantly stiffer than the Mason Allen technique. The repair time was comparable across all 3 techniques. Conclusions: The Figure-eight and Perimeter repairs were found to be similar in peak failure point and stiffness, whereas the Mason Allen technique showed significantly lower stiffness and peak failure point. The Figure-eight was the quickest repair to perform. The Figure-eight technique may be strongly considered for muscle laceration repairs due to its simplicity and efficiency.

Traumatic Mid-substance Isolated Vastus Medialis Rupture in a Young Athlete

“…Some reports and case studies have documented improved outcomes when treating with surgical interventions 5,[9][10][11][12] . The various suturing techniques for surgical primary muscle repair may have less predictable outcomes and are at risk of suture failure requiring further interventions [6][7][8][9][10][11][12] . Cases have reported promising results using mesh to augment surgical repair; however, there is a requirement for further studies before widespread implementation can be supported 23 .…”

“…Tendinous injury repairs present a more standardized approach to repair using anchors and bone tunneling, whereas mid-substance muscle tears involving complete separation of the 2 portions of muscle present a surgical challenge. Some reports and case studies have documented improved outcomes when treating with surgical interventions 5,[9][10][11][12] . The various suturing techniques for surgical primary muscle repair may have less predictable outcomes and are at risk of suture failure requiring further interventions [6][7][8][9][10][11][12] .…”

“…Mid-substance tears pose a more difficult decision when determining the ideal treatment plan. Surgical repairs of mid-substance tears have shown improved healing in mouse models; however, clinically, they are invasive and at risk of repair failure necessitating further interventions 5,6,[8][9][10][11][12] . Conservative treatment is prone to a longer recovery with high risk of setbacks and reinjury due to the limited regenerative potential of muscle and scarring 8,11,13,14 .…”

Bioinductive Collagen Implant Augmentation for Myotendinous Achilles Rupture in a Teenage Competitive Gymnast

“…Surgical options include open vs. percutaneous primary repair. Ruptures at the myotendinous junction represent particularly challenging repairs because the muscular proximal limb has less ability to hold suture than the tendinous distal limb 20,21 . Biologic augmentation for Achilles repair has been studied.…”