Understanding In Vivo Abrasion Fatigue of Common Suture Materials Used in Arthroscopic and Open Shoulder Surgery (original) (raw)
Related papers
Journal of Orthopaedic Research, 2013
In orthopedic surgery, the reattachment of tendon to bone requires suture materials that have stable and durable properties to allow time for healing at the tendon-bone interface. The suture, not rigidly restrained within the anchor eyelet, is free to move during surgery and potentially after surgery with limb motion. During such movement, the suture is subjected to bending and frictional forces that can lead to fatigue-induced failure. We investigated some common contemporary commercial number-two-grade suture materials and evaluated their resistance to bending abrasion fatigue and the consequent failure. Sutures were oscillated over a stainless steel wire at low frequency under load. Number of abrasion cycles to failure, changes in suture morphology, and fatigue-failure method was recorded for each material. Suture structure had a significant effect on abrasion resistance, with braided sutures containing large numbers of fine high tenacity core filaments performing15-20 times better than other braided suture structures. Ultra high molecular weight polyethylene (UHMWPE) core filaments resisted bending abrasion failure better than other core materials due to the load spreading and abrasion resistance of these filaments. Sutures with UHMWPE cores also had high resistance to tensile failure. Limited correlation was observed between tensile strength and abrasion resistance. ß
Handling characteristics of braided suture materials for tight tying
Journal of Applied Biomaterials, 1993
To establish criteria for characterizing synthetic sutures, the handling characteristics of silk suture were analyzed. The characteristics that distinguish silk suture from other braided suture materials are its good "knot security" and relatively low "tiedown resistance." Analytic consideration of knot security suggests that not only superficial friction but also resistance force produced by cross-sectional deformity of braided threads plays an important role in silk's superior performance. Results of a "pullout friction test," developed to quantitatively evaluate resistance produced by surface friction and cross-sectional deformity suggest that the superiority of silk thread can be explained in terms of high static withdrawal resistance under low loads and relatively low dynamic withdrawal resistance under high loads.
Evaluation of Suture Abrasion Against Rotator Cuff Tendon and Proximal Humerus Bone
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2008
Purpose: This study evaluates the abrasion properties of different suture materials through the rotator cuff tendon and proximal humerus tuberosity bone. Methods: Three types of sutures were compared: monofilament polypropylene, braided polyester, and braided polyblend polyester with a polyethylene core. For soft-tissue testing, the suture was passed through the infraspinatus tendons of 11 cadaveric shoulders. The suture was cycled with a fixed load, and the migration of the suture as it cut through the tissue was measured at intervals of 5 cycles, for a total of 50 cycles. For tuberosity testing, the sutures were passed through a transosseous tunnel created in the lesser tuberosity, and the suture was cycled with a fixed load until suture failure occurred. Results: On soft-tissue testing, the monofilament suture showed the least amount of abrasion, followed by the braided polyblend and then the braided polyester suture (cutting rate of 0.06 Ϯ 0.11 mm/cycle, 0.99 Ϯ 0.44 mm/cycle, and 1.75 Ϯ 0.91 mm/cycle, respectively; P Ͻ .0001). On tuberosity testing, suture breakage for the braided polyblend suture occurred at 501.3 Ϯ 220.4 cycles. The braided polyester and monofilament sutures broke after 256.6 Ϯ 120.9 and 193.5 Ϯ 144.8 cycles, respectively. The difference between cycles to failure of the polyblend and latter 2 sutures was statistically significant (P Ͻ .0001). Conclusions: This study shows increased abrasion properties for braided sutures compared with monofilament sutures, as well as different abrasion properties among different types of braided sutures. Furthermore, the braided polyblend suture showed significantly increased cycles before suture failure through a transosseous tunnel. Clinical Relevance: Although development of new suture materials has increased their failure strength, further advancements in suture material design should focus on decreasing soft-tissue abrasion properties and increasing strength to suture failure when cycled through bone.
Tensile mechanics of braided sutures
Textile Research Journal, 2012
Sutures are the materials primarily used for closing wounds, and their performance is significantly dependent on their mechanical characteristics. Thus, their tensile property is a key parameter responsible for the success of a suture. In this paper, a simple analytical tensile model of braided sutures has been developed based on braid geometry, braid kinematics, and constituent monofilament properties. The model has accounted for the changes in the braid geometry, including braid angle, diameter, and Poisson’s ratio. The kinematics of the braided suture is analyzed pertaining to monofilament locking or jamming in the braid. The model of jamming state of monofilaments has been presented, and both braid angle and diameter are found to be critical design parameters. The experimental results have been compared to the theoretical stress–strain curves of braided sutures, and an excellent agreement has been observed between them.
Mechanical testing of different knot types using high-performance suture material
Knee Surgery, Sports Traumatology, Arthroscopy, 2013
Purpose This laboratory study aimed to evaluate the loop security, knot security, cyclic loading resistance and loadto-failure rate of three different knot types with establishing a new experimental setup. Additionally, the mode of failure of each knot was evaluated. Methods With the use of nonabsorbable, braided polyethylene sutures, USP size No. 2 [Hi-Fi Ò ; ConMed Linvatec], the arthroscopic knot types Dines, SMC as well as the surgeon's knot were tested using a material testing machine. The knots were tied openly as well as arthroscopically. The setup enables testing of knot configurations while eliminating friction between knot loop and its suspension points. Including all test procedures, a total of 216 knots were tested. Results All openly tied knot types and ten of each type of arthroscopically tied knots resisted against cyclic loading of 1,000 cycles. With subsequent load-to-failure testing, openly tied knot types achieved significantly higher values of tensile strength than arthroscopically tied knots. Regarding clinical failure, defined as an elongation of 3 mm, Dines knot reached highest loop as well as knot security. Knot slippage was the most common failure mechanism at an elongation of 3 mm, whereas suture breakage was evaluated most at an elongation of 6 mm. Conclusions The new experimental setup confirms the loop security of arthroscopic knot types. Using a knot pusher clinically is a key factor to attain this as compared to openly hand-tied techniques. The Dines knot presented the highest reliability. It may provide a secure tissue healing during rehabilitation and consequently can be recommended for clinical application.
Veterinary Surgery, 2010
Objective-To evaluate the effect of 6 different knotting methods on the mechanical properties of 3 large absorbable suture materials used in large animal surgery. Study Design-In vitro mechanical study. Sample Population-Knotted suture loops (n=15 per group). Methods-Suture loops were created between two low-friction pulleys with either 2 polydioxanone, 2 polyglactin 910 or 3 polyglactin 910. Strands were tied using 1 of 6 knotting technique: square knot, surgeon knot, clamped surgeon's knot, sliding half-hitch knot (HH), Delimar knot and self-locking knot (SLK). A single cycle to failure test was performed on each suture loop with a distraction rate of 100 mm/min. Failure modes were evaluated and breaking strength, elongation to failure and stiffness were compared. Results-All loops except two HH failed at the knot by acute breaking. The double-stranded SLK was both stronger and stiffer than all other knots for each suture material. Clamping the first throw of the surgeon knot decreased load to failure significantly (143.11 AE 8.64 N) compared with not clamping (159.21 AE 6.14 N) for polydioxanone. Stiffness and elongation to failure were respectively lower and increased for 2 polydioxanone compared with both polyglactin 910 materials for all knotting techniques. Conclusions-Knotting techniques do influence structural properties of suture loops. The double strand loop conferred stiffer and stronger properties to the SLK Clinical Relevance-Clamping the first throw of polydioxanone should be avoided when tying a suture under tension even using large diameter suture materials. Using a SLK might be considered as a useful alternative when excessive tension is present.
The effect of suture anchor design and orientation on suture abrasion: An in vitro study
Arthroscopy: The Journal of Arthroscopic & Related Surgery, 2003
To evaluate the effects of suture anchor design and orientation on suture abrasion in a cyclic model. Type of Study: In vitro. Methods: Biomechanical studies have shown suture breakage to be a predominant mode of failure in a suture anchor repair construct. It is possible that suture abrasion during knot tying or in vivo cyclic loading may contribute to early failure. This study specifically investigates suture abrasion caused by 17 commonly used suture anchors and demonstrates the effects of suture anchor angulation and rotation on suture abrasion. To eliminate target tissue as a source of failure, all anchors were implanted into a solid block of sawbones material and tested with No. 2 Ethibond Excel sutures (Ethicon, Somerville, NJ). The testing model focused on 3 variables: suture anchor type, suture pull angle (SA) and angle of anchor rotation (RA). Abrasion testing was then performed on a servohydraulic materials testing system by continually cycling the suture back and forth through each anchor with an excursion of 4 cm at a rate of 0.5 Hz under a load of 10 N until suture failure occurred. Results: Sutures performed significantly better when cycled in line with the anchor at 0°SA with 0°RA than they did at 45°SA with 0°RA or 45°SA with 90°R A. We found no significant difference between anchors tested at 45°SA with 0°RA and 45°SA with 90°RA. For tests performed using metallic suture anchors, all constructs failed by fraying of the suture. Constructs using biopolymer anchors and nonabsorbable polymeric anchors experienced a mixture of suture and anchor eyelet failures. Conclusions: In addition to the statistically significant detrimental effects of suture anchor angulation and rotation on suture abrasion, suture anchor eyelet design may also influence suture abrasion. Surgeons should be aware of the effects of anchor angulation, suture position in the eyelet, and design and composition of the eyelet to maximize the durability of the construct.
HAND, 2014
Background Flexor tendon repair in zone II remains a vexing problem. Repair techniques have been developed to strengthen and optimize the number of core strands crossing a repair. A polyamide looped suture doubles the number of core strands for every needle path. This simplifies repairs, but the knot remains a potential weakness. The purpose of our study was to create a biomechanical model used to evaluate the bulky knot of a looped suture as it may be weaker, resulting in greater deformation. Methods Using machined steel rods to hold our suture constructs, we compared four different knot configurations using looped and non-looped sutures in 3-0 and 4-0 varieties using a four-core strand technique. The constructs were tested under increased cyclic loading recording both forces applied and suture construct lengthening ("clinical gapping") and ultimate breaking strength. Results During continuous periods of cyclic loading, we measured permanent deformation and ultimate breaking strength. Permanent deformation results when there is no recoverable change after force removal defined as a permanent rod separation (or gapping) of 2 mm. Four-strand 3-0 and 4-0 looped sutures failed at 39.9 and 27.1 N faring worse than a four-strand non-looped suture which reached a rod separation of 2 mm at 60.7 and 41.3 N. The ultimate breaking strength demonstrated absolute failure (construct rupture) with the 3-0 looped suture breaking at the knot at 50.3 N and the non-looped suture at 61.5 N. For the 4-0 suture, these values were 32.4 and 41.76 N. Conclusion Within the constraints of this model, a looped suture fared worse than a non-looped suture especially when comparing 4-0 and 3-0 sutures. However, two-knot 3-0 looped suture constructs did resist the force generally accepted as occurring with early non-resistive tendon motion protocols, while two-knot 4-0 looped suture constructs did not. Clinical Relevance This paper provides a description of a model to evaluate various suture materials and knot strengths in isolation of the tendon itself. This allowed us to evaluate mechanical differences between looped and non-looped sutures for polyamide, which are commonly used in flexor tendon repair. These differences between sutures may impact choices for a suture type selected for these repairs.
Material properties of common suture materials in orthopaedic surgery
The Iowa orthopaedic journal, 2010
Suture materials in orthopaedic surgery are used for closure of wounds, repair of fascia, muscles, tendons, ligaments, joint capsules, and cerclage or tension band of certain fractures. The purpose of this study was to compare the biomechanical properties of eleven commonly used sutures in orthopaedic surgery. Three types of braided non-absorbable and one type of braided absorbable suture material with different calibers (n=77) underwent biomechanical testing for maximum load to failure, strain, and stiffness. All samples were tied by one surgeon with a single SMC (Seoul Medical Center) knot and three square knots. The maximum load to failure and strain were highest for #5 FiberWire and lowest for #0 Ethibond Excel (p<0.001). The stiffness was highest for #5 FiberWire and lowest for #2-0 Vicryl (p<0.001). In all samples, the failure of the suture material occurred at the knot There was no slippage of the knot in any of the samples tested. This data will assist the orthopaedic ...