Performance of a knotless four-strand flexor tendon repair with a unidirectional barbed suture device: a dynamic ex vivo comparison

Abstract

With increased numbers of reports using barbed sutures for tendon repairs we felt the need to design a specific tendon repair method to draw the best utility from these materials. We split 30 sheep deep flexor tendons in two groups of 15 tendons. One group was repaired with a new four-strand barbed suture repair method without knot. The other group was repaired with a conventional four-strand cross-locked cruciate repair method (Adelaide repair) with knot. Dynamic testing (3–30 N for 250 cycles) and additional static pull to failure was performed to investigate gap formation and final failure forces. The barbed suture repair group showed higher resistance to gap formation throughout the test. Additionally final failure force was higher for the barbed suture group compared with the conventional repair group. When used appropriately, barbed suture materials could be beneficial to use in tendon surgery, especially with regard to early loading of the repair site and gap formation.

Barbed Sutures and Tendon Repair—a Review

“…Their results reveal a statistically significant higher load to failure for the barbed suture repair as compared to both the traditional Adelaide repair and the 3D traditional suture repair [30].…”

“…However, the novel 3D unbarbed suture repair mode of failure was split nearly evenly among knot rupture and suture pullout. The majority of failures in the barbed suture repair were due to suture breakage, with a minority due to suture pull out [30].…”

“…5). Peltz et al performed a novel 3D barbed suture repair [30] (see Fig. 6), and Trocchia performed a variation of the Kessler-Bunnel technique [35] (see Fig.…”

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?

“…Studies have measured such digital flexor tendon forces up to 34.32 N 13 during active unresisted finger motion in vivo. Other studies have helped to optimize gap resistance in tenorrhaphy by repairing with a higher strand count, 14 utilizing locked 4-strand cruciate (Adelaide) over nonlocked constructs, 4 4-mm cross-locks over 2-mm cross-locks, 10 and 10-mm core suture purchase length over 4-mm purchase. 10 Although initially advocated as a cosmetic stitch to improve gliding, peripheral repairs added to core repair have also been found to improve repair strength, 5,17 and it was shown that 6-0 nylon Silfverskiöld peripheral repair increased 3-mm gap resistance by almost 200%.…”