In Vitro Comparison of Two Barbed Suture Configurations for Flexor Tendon Repair

Abstract

The current study compares the strength of a previously studied technique for flexor tendon repair with barbed sutures to an experimental approach that aligns all the barbs to oppose distraction. Twelve flexor tendons from cadaveric specimens were mechanically tested following repair of simulated zone II tendon injuries. Two repair techniques utilizing barbed sutures were studied: the Marrero-Amadeo four-core barbed suture approach and the experimental configuration with all barbs on four cores opposing distraction. Maximum applied load at failure, that is, ultimate load, and 2-mm gap force were compared between the two repair techniques, both as raw values and after normalization to cross-sectional area of the intact tendon. Statistical testing was performed using -tests and Mann-Whitney -tests, where appropriate, with a significance level of 0.05. The ultimate loads, raw (58.2 N) and normalized (4.8 N/mm ), were significantly larger for the Marrero-Amadeo repair than the proposed experimental approach (35.6 N and 2.7 N/mm ; < 0.05). No significant differences were identified for 2-mm gap force. The innovation of suturing to align all barbs to oppose distraction does not improve strength of the repaired tendon. The Marrero-Amadeo technique was found to have superior strength for use in traumatic zone II flexor tendon injuries.

Barbed sutures versus conventional tenorrhaphy in flexor tendon repair: An ex vivo biomechanical analysis

“…Regardless of the suture material and technique, the most common mode of failure in our study was suture pull-out. Previous studies have demonstrated that traditional repairs failed mostly by suture rupture, whereas barbed suture repairs most commonly failed by either suture pull-out or breakage 3 7 11 , 14 16 . The discrepancy in the mode of failure between our study and previous reports may be due to differences in the tendon model that was used and the suture purchase length for repairs.…”

“…Advances in suture materials reintroduced the possibility of using barbed sutures for tendon repairs. The advantages of barbed tenorrhaphy are minimal bulk and lower gliding resistance due to the knotless design, better load distribution along the entire suture length caused by the barbs locking into the tendon, and improved tendon flow resulting from the reduction of constricting forces [1,3,5]. Furthermore, the barbed suture technique is quicker than other techniques, and is easy to perform and less demanding in terms of surgical skills.…”

“…The management of flexor tendon injuries has evolved in recent years through industrial improvements in suture materials, refinements of repair methods, and early rehabilitation protocols [1][2][3][4][5][6]. However, there is no consensus on the ideal suture mate-Barbed sutures versus conventional tenorrhaphy in flexor tendon repair: An ex vivo biomechanical analysis rial and technique, which would provide low friction with minimal bulk and sufficient tensile strength to allow early motion without any risk of failure [3,7].…”

“…The management of flexor tendon injuries has evolved in recent years through industrial improvements in suture materials, refinements of repair methods, and early rehabilitation protocols [1][2][3][4][5][6]. However, there is no consensus on the ideal suture mate-Barbed sutures versus conventional tenorrhaphy in flexor tendon repair: An ex vivo biomechanical analysis rial and technique, which would provide low friction with minimal bulk and sufficient tensile strength to allow early motion without any risk of failure [3,7]. Currently, the most popular method of zone II flexor tendon repair is a minimum of 4-strand conventional knotted core repair with braided, nonabsorbable sutures [7,8].…”