Influence of barbed epitendinous sutures combined with a core locking-loop suture to repair experimental flexor tendon lacerations.

Abstract

To determine the influence of barbed epitendinous sutures (ES) on the biomechanical properties and gap formation of repaired canine tendons. Ex vivo, experimental study. Eighty (n = 16/group) canine superficial digital flexor tendons (SDFT). After transection, SDFT were repaired with a locking-loop (LL) pattern alone (group 1), an LL + smooth ES with monofilament suture (group 2), an LL + V-loc-ES (group 3), an LL + Quill-ES (group 4), or an LL + Stratafix-ES (group 5). All core LL repairs were performed with 0 USP polypropylene, and all ES were placed with 2-0 USP equivalent. Constructs were preloaded and tested to failure. Yield, peak, and failure loads; occurrence of gap formation; and failure modes were compared. Yield loads were greater for groups 2 and 5 (P < .0001). Peak and failure loads were greater when an ES was used (P < .005), especially for groups 2 and 5 (P < .0001). Groups with an ES required higher loads to generate 1- and 3-mm gaps compared with specimens without an ES (P < .002). Force to create 1- and 3-mm gaps was greater for group 5 (P < .0001) and groups 2 and 5 (P < .0001), respectively. Failure mechanism did not differ (P = .092) between ES groups, consisting of suture breakage in 51 of 64 constructs compared with pull-through in seven of 16 group 1 constructs. Epitendinous suture placement improved the biomechanical properties of repaired tendons. Stratafix barbed suture performed better as an ES compared with other barbed sutures and similarly to monofilament suture. Stratafix barbed suture eliminates the requirement for knot tying and seems to be equivalent to smooth monofilament suture when used as an ES in this pattern.