Comparison of the mechanical properties and anchoring performance of polyvinylidene fluoride and polypropylene barbed sutures for tendon repair

Abstract

Polyvinylidene fluoride (PVDF) has been considered as an alternative suture material to replace polypropylene (PP) due to its superior biocompatibility and mechanical properties, but it has never been examined for use in barbed sutures, particularly for tendon repair. This study fabricated size 2-0 PVDF and PP bidirectional barbed sutures and compared their mechanical properties and anchoring performance in patellar tendons. The mechanical properties were evaluated via tensile testing, and the anchoring performance of the barbed sutures was assessed by a tendon suture pullout test. Sixty porcine patellar tendons were harvested, transected to mimic a full-thickness injury, and repaired using a cross-locked cruciate suturing technique. The ultimate tensile force was 60% higher for the PVDF barbed sutures (22.4 ± 2.1 N) than for the PP barbed sutures (14.0 ± 1.7 N). The maximum pullout force was 35% higher for PVDF barbed sutures (70.8 ± 7.8 N) than for PP barbed sutures (52.4 ± 5.8 N). The force needed to form a 2-mm gap, indicative of repair failure, was similar between the PVDF (29.2 ± 5.0 N) and PP (25.6 ± 3.1 N) barbed sutures, but both were greater than the 2-mm-gap forces for non-barbed sutures of the same size. In this study, PVDF barbed sutures provided better mechanical properties and improved tissue anchoring performance compared to the barbed PP sutures for porcine patellar tendon repair, demonstrating that PVDF monofilament sutures can be barbed and used effectively for tendon repair.

Future prospects and recent developments of polyvinylidene fluoride (PVDF) piezoelectric polymer; fabrication methods, structure, and electro-mechanical properties

“…PVDF as a biomaterial has been used in bone, 45 neural 83 and muscle tissue regeneration, 84 abdominal hernia repair, 85 endothelialization, vascular surgery, 66 and tissue sensors. PVDF copolymers and PVDF-TrFE have also been reported as bone regeneration, neural tissue, and wound healing fibers and membranes.…”

“…46 PVDF is now being used in the medical industry as medical textiles and surgical meshes, drug delivery, tissue engineering, surgical sutures, and implants. 66 PENG devices based on PVDF have the exibility to achieve twistable, foldable characteristics, and stretchability, which is ideal for wearable electronics such as biomechanical monitoring units or energy supply units (Fig. 24).…”

A Review of Barbed Sutures—Evolution, Applications and Clinical Significance

“…In his patent, Dr. Alcamo had reported the design of these sutures ( Figure 2 ) with unidirectional projections, teeth or depressions, which would enable surgeons to use these sutures for tissue approximation without the need to tie a knot. Since his designs were all unidirectional, surgeons had to “double back” to ensure complete closure of an incision or an open wound [ 3 , 6 , 15 , 16 ].…”

“…He mentioned that the sutures were made of nylon, silver, stainless steel or tantalum filaments. Dr. McKenzie had also mentioned that the bidirectional barbed sutures would facilitate the handling and widen the potential applications for surgeons since they were not required to “double back”, as described earlier by Dr. Alcamo with his unidirectional barbed suture design [ 3 ].…”

“…Wound closure devices are specifically designed to close a wound by holding the diseased, injured or incised tissue together with the help of one of the following devices: surgical sutures, staples, surgical zippers, clips, adhesive tape or adhesive strips, tissue adhesives or laser bonding. These devices are widely used to close cutaneous or skin wounds [ 3 , 4 ], and are designed and fabricated from various materials depending on the precise anatomical site and the function of the approximated tissues. These devices can either be fabricated from permanent or biodegradable materials depending on the longevity of their active function in vivo [ 2 , 5 ].…”