Biomechanical Evaluation of a Novel Barbed Suture Pattern with Epitendinous Suture Augmentation in a Canine Flexor Tendon Model

Introduction: Barbed suture may be advantageous for use in surgical tenorrhaphy due to lack of requirement for suture knotting. Our objective was to determine the effect of a novel barbed suture pattern (NBSP) compared with a three-loop-pulley (3LP) with and without epitendinous suture (ES) augmentation.

Materials and Methods: Superficial-digital-flexor-tendons (SDFT) were randomly assigned to one of four groups (n = 10/group). Sharp tenotomy was performed and repaired with 3LP, NBSP, 3LP+ES, and NBSP+ES. Constructs were tested to failure while evaluating yield, peak, and failure loads, loads at 1- and 3-mm gap formation, and failure mode.

Results: Constructs augmented with ES sustained 80% greater yield (p <0.001), peak (p <0.001), and failure (p <0.001) loads, with no difference between 3LP+ES and NBSP+ES constructs regarding peak (p = 0.614), and failure forces (p = 0.865). Loads resulting in 1- and 3-mm gap formation were greater when constructs were augmented with an ES (p ≤0.003). Failure mode differed between groups (p <0.001), occurring predominantly due to suture pull-through in 3LP and NBSP groups compared with tissue failure distant to the repair site in ES augmented constructs.

Discussion/Conclusion: Tendons repaired with the NBSP resisted similar forces as those repaired with 3LP. Augmentation with an ES improved the biomechanical properties of repaired constructs, including resistance to gap formation. The 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. Limitations include the inability to assess how the NBSP will translate for use in smaller, flatter, or sheathed tendons with decreased tissue available for barb purchase.

Acknowledgement: No proprietary interests or funding existed for this project.

Publication History

Article published online:
26 October 2022