The Effect of Different Suture Materials on Achilles Tendon Metabolism: A Preliminary in vivo Study of mRNA levels in Rabbits

Sixty patients were systematically reviewed from the authors prior studies specifically for outcomes using bioabsorbable suture anchors who underwent repair of their Achilles insertion, with minimum two years post-index procedure. Fifty-five were chronic cases with and without calcific tendinosis and 5 were acute avulsions. Average age of the cohort was 51.5 ± 12.7 years. There were 38 males and 22 females. Thirty patients had their right limb operated on: 30 their left. Average return to activity was 6.9 ± 1.7 months. Average post-op VISA-A score was 94.4 ± 12.8, post-op RM score 1.3 ± 0.6, and calf atrophy 0.7 ± 1.0 cm calculated at the last post-op appointment. The ability to single leg heel raise was achieved in 45 patients: equal to the other limb 27. 95% of patients were able to return to full activity including sports. Two were Olympians. Complications were as follows: one DVT, one infection, three hypertrophic scars due to superficial suture and one subcutaneous suture reaction from a braided absorbable product. There were no re-ruptures, no suture granulomas/reactions from the Orthoc-ord™ suture and no suture anchor failures. The repair typically involved one anchor superiorly at the Achilles insertion with a suture anchor and 2 partially absorbable suture with needles. Two additional anchors are placed inferiorly that were knotless. A total of 180 Healix™ Advance BR anchors were used, 62 were 5.5 mm Healix™ Advance BR with Orthocord and needles, 104 Healix™ Advance Knotless BR 5.5 mm, and 14 Healix™ Advance Knotless BR 4.75 mm. Using this repair technique for Achilles insertion repair has good outcome with low complication rate.

Section: Discussionmentioning

confidence: 99%

Insertional Achilles Tendon Repair with Bioabsorbable Anchors and Suture

Gaudin¹,

Saxena²

2022

“…Inflammatory reaction to a bsorbable sutures in tendons may be a matter of concern (14,18,20,74). However, because of relatively quick degradation, inflammatory response to absorbable sutures is shorter than that to non-absorbable ones.…”

Section: Outcomementioning

confidence: 99%

Flexor Tendon Repair with Fast-Absorbable Sutures: A Rupture Incidence-Focused Analysis of a Case Series and a Review

Macionis

2024

Hand flexor tendon repair with absorbable sutures has the advantage of leaving no foreign material within the tendon. However, clinical application of degradable materials in flexor tendon repair is limited to slow-absorbable PDS or Maxon sutures and commonly does not involve fast-absorbable sutures, probably, because of fear of ruptures. Meanwhile, a small number of reports have shown that in terms of tenorrhaphy failure fast-absorbable sutures are safe. It is also known that classical tendon repairs with a pull-out wire withstand intensive mobilization after wire removal. Furthermore, experimental research implies that fast-absorbable polyglycolic acid fibers seeded with tenocytes can strengthen tendon repair. The current article retrospectively analyses a series of 12 patients with predominantly complex hand injuries, in which 17 flexor digitorum profundus and four flexor pollicis longus tendon repairs with Vicryl (polyglactin 910, copolymer of polyglycolic and polylactic acid) were performed. Early postoperative passive mobilization was employed. The postoperative results were analyzed with particular reference to tenorrhaphy failure. Ruptures occurred in only two repairs. This was statistically insignificant when compared with a hypothetical set of cases consisting of only good and excellent outcomes. These results imply that hand flexor tendon repair with fast-absorbable sutures is rupture-safe if moderate postoperative mobilization is employed. However, as the calculated postoperative dynamics of the tenorrhaphy strength predicts failure of all fast-absorbable suture repairs during active motion at six weeks, more research is needed to clarify why this was not the case in the presented and other published series of patients.

“…In an acute tendon rupture model, Ergun et al performed Achilles tendon repair with different suture materials. It was found that the biological properties of absorbable PDS sutures were superior compared to Vicrl and Ethibond sutures, and the study suggests using absorbable PDS sutures in Achilles tendon repairs (12). Su et al investigated the effect of suture absorbability on enthesis regeneration and biomechanical properties in an acute rotator cuff healing model in rabbits (7).…”

Section: Introductionmentioning

confidence: 99%

Rotator Cuff Repair with Different Suture Materials Results in Different Protein Expressions with Similar Histological Findings. An Experimental Study in Rabbits

Okay

Bezer

2020

Background. Previous studies have evaluated the biomechanical, histological, and clinical effects of rotator cuff repair with different suture materials. However, a histological and western blot analysis after repair comparing nonabsorbable polyester and polyethylene suture materials in a chronic rotator cuff tear model has not been conducted in any previous studies. The aim of this study is to evaluate the effect the two different suture materials, specifically Ethibond and Ultrabraid, have on repair based on a histological evaluation and protein expression by means of a western blot analysis. Methods. Twenty-six rabbits were included in the study. Two rabbits served as normal controls (control group). A bilateral tenotomy of the subscapularis tendon was performed in the remaining 24 rabbits. Six weeks after the tenotomy, the animals were randomly divided into four repair groups (five rabbits in each group) according to the suture material used and the sacrifice time (Ultrabraid two weeks after repair, Ethibond two weeks after repair, Ultrabraid six weeks after repair, and Ethibond six weeks after repair). Two sham-operated groups with two rabbits each were sacrificed at eight and 12 weeks after the tenotomy without repair. Both shoulders of all the animals were used for a western blot (collagen type 1-3, MMP-2, TGF-beta-1, IGF-1, COX-2) analysis and a histological evaluation (fibrocartilage formation, inflammation, vascularisation, collagen density). Results. All groups showed minimal-to-mild histological changes irrespective of the type of suture material used. There was no statistically significant difference in histological scores (p > 0.05). Fibrocartilage formation was greater at six weeks in the polyester suture repair groups without statistical significance (p > 0.05). Collagen type 1-3, MMP-2, TGF-beta-1, IGF-1, and COX-2 were significantly upregulated at two weeks compared to six weeks after repair (p < 0.05). Protein expression levels were statistically significantly higher in the Ultrabraid groups compared to the Ethibond groups (p < 0.05). Conclusions. Changes in the expression of the markers related to rotator cuff healing were demonstrated when repairing with different suture materials, with these being in favour of polyester sutures; however, the histological findings are similar. This finding could influence the design of new suture materials.