Effect of suture caliber on the tensile strength of tenorrhaphies in cadaveric canine tendons

Abstract

OBJECTIVE To evaluate the effect of suture caliber on the tensile strength of tenorrhaphies performed with a locking-loop technique in cadaveric canine tendons SAMPLE 60 superficial digital flexor tendons (SDFTs) from 30 cadaveric adult dogs. PROCEDURES Transverse tenotomy was performed, and SDFTs were repaired with a locking-loop technique and polypropylene suture of 5 randomly assigned calibers: size-0, 2-0, 3-0, 4-0, or 5-0 (n = 12 SDFTs/suture caliber). Tendon constructs were tested to failure. Yield, peak, and failure forces and causes of failure were compared between groups. RESULTS Mean ± SD failure force for the constructs was significantly greater with large-caliber suture (size-0: 73.5 ± 3.1 N; size 2-0: 54.4 ± 7.1 N; size 3-0: 28.7 ± 4.9 N; size 4-0: 18.7 ± 3.4 N; and size 5-0: 8.8 ± 2.8 N). The likelihood of construct failure by suture pullout through the tendon substance increased with large-caliber suture (size-0: 12/12), whereas the likelihood of construct failure by suture breakage increased with small-caliber suture (2-0: 10/12; 3-0, 4-0, and 5-0: 12/12 each). CONCLUSIONS AND CLINICAL RELEVANCE Large-caliber suture had greater tensile strength for tenorrhaphies performed with a locking-loop technique in cadaveric canine tendons. Prior to the use of large-caliber suture in patients requiring tenorrhaphy, however, in vivo studies are required to confirm the results obtained here.

Biomechanical analysis of accessory tendon graft augmentation for primary gastrocnemius tendon reconstruction in dogs

“…Due to the protracted period of tendinous healing following surgery, the limb is often supported to offload the repair with the talocrural joint held in extension by application of casts, calcaneotibial screw placement, or transarticular external skeletal fixation, applied for a period of at least 6 weeks to protect the primary repair 3,19 . Factors shown to affect the way in which repaired constructs fail include the inherent strength and functional integrity of anastomosed tissues, core suture size, and the number of suture strands crossing the repair 20‐22 . In clinical cases, failure of the primary repair may occur due to suture breakage or suture pull‐through.…”

Ex vivo evaluation of novel core tenorrhaphy patterns in dogs

“…We demonstrated that that tendons repaired with ExDCrL were stronger than 3LP and TCiL. We hypothesize these observed findings relate to the suture patterns, as other extraneous confounding variables; tendon type, bite distance from the transection site, 44 suture material, 45 and suture size 46 which affects construct strength were controlled during testing.…”

“…50 It is plausible that if a larger suture was used for tenorrhaphy that different results may have been obtained. 46 The clinical application of these novel patterns in dogs requires further in vivo evaluation. Factors that were not examined as part of this experimental design include the effect of these novel patterns on the local tendinous blood supply.…”

“…Putterman et al evaluated tendons repaired with core 3LP with and without epitendinous suture augmentation and observed that pull‐through was the most common failure mode in tendons repaired with 3LP 50 . It is plausible that if a larger suture was used for tenorrhaphy that different results may have been obtained 46 …”

Ex Vivo Biomechanical Assessment of a Novel Multi-Strand Repair of Canine Tendon Lacerations

“…42 To date, knowledge regarding surgical factors and successful outcomes during human tendinous repair have been established in comparative animal studies. 14,16,19,32,43,44 In addition to the number of core suture strands crossing the repair, 44 the calibre of the core suture, 45,46 depth of core suture penetrance, 47 placement of an epitendinous suture, 40 depth of epitendinous placement 48 and increasing the distance of epitendinous suture bite placement from the transection site 48 have all been identified as important surgical factors regarding the repair. Sequential increases in each of these evaluated variables resulted in increased strength, stiffness and resistance of the repair to the development of gap formation.…”