Scientific article
Biomechanical Evaluation of Flexor Tendon Repair Using Barbed Suture Material: A Comparative Ex Vivo Study

https://doi.org/10.1016/j.jhsa.2010.11.031Get rights and content

Purpose

Barbed suture material for tendon repair opens up the possibility of a knotless reconstruction due to an increased suture–tendon interaction. The aim of this study was to compare the tensile strength of a knotted technique with a monofilament polydioxane suture to that of a knotless technique with a barbed suture material, by using a multistrand, modified Kirchmayr-Kessler tenorrhaphy.

Methods

Sixty human flexor digitorum tendons were randomized into 4 groups. A modified, knotted, multistrand Kirchmayr-Kessler technique with an absorbable, monofilament polydioxane suture was compared with a modified, knotless, multistrand Kirchmayr-Kessler technique with an absorbable, unidirectional barbed glycolic-carbonate suture. Tendons were distracted to failure. Mode of failure and load to failure were recorded.

Results

The knotless 2-strand Kirchmayr-Kessler barbed suture shows a significantly lower tensile strength than the knotted 2-strand polydioxane suture (p < .001). The comparison of the maximum tensile strength of the knotless (glycolic-carbonate) technique with that of the knotted (polydioxane) 4-strand technique resulted in no significant difference in either technique utilized (p = .737). The tensile strength of the 4-strand technique was greater than that of the corresponding 2-strand technique (p < .001).

Conclusions

The 2-strand Kirchmayr-Kessler barbed suture proved to be insufficient and significantly weaker than the 2-strand polydioxane suture, and therefore it cannot be recommended. With the knotless 4-strand Kirchmayr-Kessler technique, the barbed suture material has the potential to be used in flexor tendon surgery, but it has no advantage over the 4-strand polydioxane suture.

Section snippets

Materials and Methods

We randomly separated 60 human flexor digitorum tendons into 4 groups and sutured them with either a modified 2-strand (groups A and B) or 4-strand (groups C and D) Kirchmayr-Kessler technique. For groups A and C, an absorbable, monofilament polydioxane suture was used (PDS 3-0; Johnson & Johnson Medical GmbH, Norderstedt, Germany). In groups B and D we used an absorbable, unidirectional, barbed glycolic-carbonate suture material (V-Loc 3-0; Covidien Deutschland GmbH). In the case of the

Results

The repairs of the knotted, 2-strand polydioxane technique and both 4-strand techniques failed in terms of suture breakage. The repairs of the knotless, 2-strand barbed suture technique failed with suture pullout. The comparison between the knotted, 2-strand polydioxane and the knotless, 2-strand barbed suture technique showed a significantly reduced value at the ultimate load (p < .001). With the 4-strand-techniques, a markedly higher maximum force was achieved when compared with the 2-strand

Discussion

Early mobilization after repairing tendon injuries is desired, as this promotes the intrinsic healing response of lacerated flexor tendons20, 21, 22 stimulation, adhesion reduction,23 and an overall improved clinical result.24, 25

To improve the biomechanical conditions, various suture materials and methods are used. Absorbable suture materials for flexor tendon tenorrhaphy are under consideration, as several authors have suggested that appropriate absorbable suture materials can be used safely

References (36)

Cited by (0)

The authors thank Melanie Henle for support. The work was done at the Wuerzburg University Hospital/Germany, Department of Trauma, Hand, Plastic and Reconstructive Surgery.

No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.

View full text