Biomechanical evaluation of a novel barbed suture pattern with epitendinous suture augmentation in a canine flexor tendon model.

Abstract

OBJECTIVE\nTo determine the effect of a novel barbed suture pattern (NBSP) compared to a three-loop-pulley (3LP) with and without epitendinous suture (ES) augmentation on the biomechanical strength and gap formation of repaired canine tendons.\n\n\nSTUDY DESIGN\nEx vivo, cadaveric, randomized, experimental study.\n\n\nSAMPLE POPULATION\nForty, adult superficial digital flexor tendons (SDFT).\n\n\nMETHODS\nSDFT were randomly assigned to one of four groups (n\xa0=\xa010/group). Sharp tenotomy was performed and repaired with 3LP, NBSP, 3LP\u2009+\u2009ES, and NBSP\u2009+\u2009ES. Constructs were tested to failure while evaluating yield, peak, and failure loads, loads at 1 and 3\u2009mm gap formation, and failure mode.\n\n\nRESULTS\nConstructs augmented with ES sustained 80% greater yield (p\u2009<\u2009.001), peak (p\u2009<\u2009.001), and failure (p\u2009<\u2009.001) loads, with no difference between 3LP\u2009+\u2009ES and NBSP\u2009+\u2009ES constructs regarding peak (p\xa0=\xa0.614), and failure forces (p\xa0=\xa0.865). Loads resulting in 1 and 3\u2009mm gap formation were greater when constructs were augmented with an ES (p\u2009≤\u2009.003). Failure mode differed between groups (p\u2009<\u2009.001), occurring predominantly due to suture pull-through in 3LP and NBSP groups compared to tissue failure distant to the repair site in ES augmented constructs.\n\n\nCONCLUSION\nTendons repaired with the NBSP used in this study resisted similar forces as those repaired with 3LP. Augmentation with an ES improved the biomechanical properties of repaired constructs, including resistance to gap formation.\n\n\nCLINICAL RELEVANCE\nThe NBSP repair tested here may be advantageous over monofilament suture repair as it uses a similar-sized barbed core suture but eliminates the requirement for knot tying.