Flexor tendon repair: a comparative study between a knotless barbed suture repair and a traditional four-strand monofilament suture repair

Abstract

Flexor tendon repair: a comparative study between a knotless barbed suture repair and a traditional four-strand monofilament suture repair. We compared the tensile strength of a novel knotless barbed suture method with a 2 traditional four-strand Adelaide technique for flexor tendon repairs. Forty fresh porcine 3 flexor tendons were transected and randomly assigned to one of the repair groups before 4 repair. Biomechanical testing demonstrated that the tensile strengths between both tendon 5 groups were very similar. However, less force was required to create a 2 mm gap in the 6 four-strand repair method compared with the knotless barbed technique. There was a 7 significant reduction in the cross-sectional area in the barbed suture group after repair 8 compared with the Adelaide group. This would create better gliding within the pulley 9 system in vivo and could decrease gapping and tendon rupture. 10 11 Strickland (1995; 2000) reported that the ideal flexor tendon repair includes safe, easily 12 placed sutures to permit the stress of early post-operative motion, close approximation 13 between the tendon sections with little gapping, congruity of the tendon ends, and a 14 minimally compromised tendon blood supply. 15 INTRODUCTIONFactors that affect the strength of a flexor tendon have been well researched and include 16 the type and diameter of suture material used (Wada et al., 2001) the number of strands 17 crossing the repair site (Barrie et al., 2000) the length of core suture purchase (Cao et al., 18 2006; Tang et al., 2005), the number of throws on the knot (Strick et al., 2004), the tension 19 of the core suture (Wu and Tang, 2012) and the method of epitendinous repair (Moriya et 20 al., 2010). Suture rupture as a cause of repair failure has almost been eliminated because of 21 advances in suture materials and the refinement of multi-strand repair techniques (Parikh et 22 al., 2009). Nowadays, the tensile strength of flexor tendon repairs is limited by inadequate 23 suture-tendon interaction at the site of locking loops as well as failure of the suture knot 24 (Tang et al., 2005; Trail et al., 1989; Xie and Tang, 2005) MATERIALS AND METHODS 20Forty fresh porcine flexor digitorum profundus tendons were obtained for our study. These 21 were chosen as they have been used in many previous studies on the tensile strengths of 22 tendon repairs. They have similar biomechanical properties to the flexor tendon of the 23 middle finger in humans (Cao et al., 2006; Hausmann et al., 2009; Mao et al., 2011; Rigó et 24 al., 2012;Smith et al., 2005; Tang et al., 2005). We examined all the tendons for any 25 4 abnormalities and imperfections including synovitis, degeneration and trauma. Those that 1 had any defects were rejected. 2 3 Cross-sectional area measurements 4To ensure all tendons were of a similar size, the height and width of each tendon was 5 measured using a caliper (Digi-Max™ Slide Caliper, Bel-Art, N.J., USA). Measurements were 6 taken at the repair site and also 1 cm proximal and 1 cm ...

Barbed Sutures and Tendon Repair—a Review

“…Joyce et al found that the barbed suture repair had a statistically higher load to 2-mm gap than the Adelaide traditional suture repair [13].…”

“…Joyce et al reported that change in tendon size with the knotless technique was significantly less than with the traditional Adelaide repair [13].…”

“…3), Parikh [20] et al performed a novel repair that resembles a multi-stranded cruciate repair [29] (see Fig. 4), and Joyce et al created a technique that is best described as a variation of the traditional Adelaide repair [13] (see Fig. 5).…”

The past, present and future in scaffold-based tendon treatments

“…Although locking loops prevent sutures from pulling, they are often associated with suture breakage and tendon rupture due to pulling of the suture at the sutured site [329]. Given that knots adversely affect gliding and locking configurations negatively impact on vascularity, barbed sutures have gained more attention as they ensure equal distribution of load throughout the intratendinous suture length [330][331][332][333][334]. Despite the significant work in the field, there is still no gold standard.…”

Does Barbed Suture Repair Negate the Benefit of Peripheral Repair in Porcine Flexor Tendon?

“…7 Studies have compared barbed suture with conventional nonbarbed suture repair of flexor tendons, with varying suture patterns, loading properties, and tendon models.…”