Flexor Tendon Repair With a Knotless, Bidirectional Barbed Suture: An In Vivo Biomechanical Analysis

Maddox, Grady; Ludwig, J.; Craig, Eric R.; Woods, David; Joiner, Aaron M.N.; Chaudhari, Nilesh; Killingsworth, Cheryl R.; Siegal, Gene P.; Eberhardt, Alan W.; Ponce, Brent A.

doi:10.1016/j.jhsa.2015.01.013

Cited by 11 publications

(17 citation statements)

References 18 publications

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“…The mid‐point of the suture length can be determined by identifying a segment that has no barbs, or by feeling for an increase in resistance as the suture is gently pulled through the tissue. This along with other commercially available barbed suture has been successfully tested in many biomechanical human and animal tendon models …”

Section: Discussionmentioning

confidence: 99%

“…This was confirmed in a recent meta‐analysis of barbed suture in flexor tendon repair compared to conventional methods . Multiple studies have also demonstrated superior tensile strength, gap formation, and final failure force of knotless barbed suture techniques compared to conventional methods, though this is also dependent on suture pattern and size . One study found that use of a knotless barbed suture technique was biomechanically inferior to a 4‐strand modified Kessler technique in a chicken model .…”

Section: Discussionmentioning

confidence: 99%

“…This along with other commercially available barbed suture has been successfully tested in many biomechanical human and animal tendon models. 12,[27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] In the human literature, the use of at least four specialized barbed sutures for flexor tendon repair was described in several studies between 1945 and 1968 but were not widely adopted. 27 Work by McKenzie 28 in 1967 involving barbed suture for the repair of flexor tendons in cadaveric models established early data regarding tensile strength of barbed suture, finding it comparable to more traditional techniques.…”

Section: Discussionmentioning

confidence: 99%

“…43 Multiple studies have also demonstrated superior tensile strength, gap formation, and final failure force of knotless barbed suture techniques compared to conventional methods, 27,[29][30][31] though this is also dependent on suture pattern and size. 32,33 One study found that use of a knotless barbed suture technique was biomechanically inferior to a 4-strand modified Kessler technique in a chicken model. 34 Regardless of repair technique, suture knots have been consistently found to be the point of tensile weakness in tendon repair.…”

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

The use of bidirectional barbed suture in the treatment of a complete common calcanean tendon rupture in a dog: Long‐term clinical and ultrasonographic evaluation

Frame

Ben‐Amotz

Simpler

et al. 2019

Clinical Case Reports

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

The use of bidirectional barbed suture in the treatment of a complete common calcanean tendon rupture in a dog: Long‐term clinical and ultrasonographic evaluation

Frame

Ben‐Amotz

Simpler

et al. 2019

Clinical Case Reports

View full text Add to dashboard Cite

show abstract

“…However, this improvement in strength comes with a penalty: knot placement outside of the repair also increases tendon gliding resistance and tissue irritation, leading to adhesion formation. In order to minimize the effect of the knots, a number of knotless approaches have been introduced using barbed sutures, with mixed outcomes [ 26 , 27 ]. The knotless modification of the 8-strand repair shown here has the potential to combine the benefits to gliding and surgical operation time of a knotless repair with the benefits to tensile strength of the Winters-Gelberman repair technique.…”

Section: Discussionmentioning

confidence: 99%

Enhanced Zone II Flexor Tendon Repair through a New Half Hitch Loop Suture Configuration

et al. 2016

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This study evaluated the impact of a new half hitch loop suture configuration on flexor tendon repair mechanics. Cadaver canine flexor digitorum profundus tendons were repaired with 4- or 8-strands, 4–0 or 3–0 suture, with and without half hitch loops. An additional group underwent repair with half hitch loops but without the terminal knot. Half hitch loops improved the strength of 8-strand repairs by 21% when 4–0, and 33% when 3–0 suture was used, and caused a shift in failure mode from suture pullout to suture breakage. 8-strand repairs with half hitch loops but without a terminal knot produced equivalent mechanical properties to those without half hitch loops but with a terminal knot. 4-strand repairs were limited by the strength of the suture in all groups and, as a result, the presence of half hitch loops did not alter the mechanical properties. Overall, half hitch loops improved repair mechanics, allowing failure strength to reach the full capability of suture strength. Improving the mechanical properties of flexor tendon repair with half hitch loops has the potential to reduce the postoperative risk of gap formation and catastrophic rupture in the early postoperative period.

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

et al. 2022

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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.

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Flexor Tendon Repair With a Knotless, Bidirectional Barbed Suture: An In Vivo Biomechanical Analysis

Cited by 11 publications

References 18 publications

The use of bidirectional barbed suture in the treatment of a complete common calcanean tendon rupture in a dog: Long‐term clinical and ultrasonographic evaluation

The use of bidirectional barbed suture in the treatment of a complete common calcanean tendon rupture in a dog: Long‐term clinical and ultrasonographic evaluation

Enhanced Zone II Flexor Tendon Repair through a New Half Hitch Loop Suture Configuration

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

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