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Does Barbed Suture Repair Negate the Benefits of Peripheral Repair in Porcine Flexor Tendon?
Alan Sull, MD; Serkan Inceoglu, PhD; Montri Wongworawat, MD
Orthopaedic Surgery, Loma Linda University Medical Center, Loma Linda, CA

Introduction: Recent advances in suture materials and geometry have fueled interest in application of barbed sutures for flexor tendon repair. Theoretically, barbed suture tenorrhaphy offers benefits in better load distribution along the entire suture length, smoother gliding under pulleys with decreased cross-sectional area under load, and improved tendon blood flow by reduction of constricting forces. Studies have compared barbed suture to conventional non-barbed suture repair of flexor tendons, with varying suture patterns, loading properties, and tendon models. Some controversy exists on whether barbed tendon repair would benefit from supplementation by a circumferential stitch. Only one study to date has reported tensile strength of barbed suture repair in flexor tendons with additional peripheral repair, but findings were limited by an unconventional model resulting in substantially higher failure loads than previously published. The purpose of this study is to determine whether peripheral repair increases gap resistance in both conventional and barbed suture core repairs, to study if peripheral repair increases ultimate tensile strength, and to examine differences in failure sequence.

Materials and Methods: Porcine flexor tendons were harvested and assigned randomly into 4 groups (3-0 PDS or 3-0 V-loc 180 core with or without peripheral 5-0 Vicryl repair). Core repairs were performed using a modified 4-strand cruciate repair with 10 mm suture purchase and 4 mm cross-locks. Knotless repair was done using barbed suture, while a buried 6-throw square knot was done using conventional suture. An servohydraulic tester was used for biomechanical testing of linear 2 mm gap resistance and maximum tensile strength.

Results: The loads at 2 mm gap formation were 22.6 3.8 N and 25.1 4.0 N for conventional and barbed suture repairs respectively, while repairs with additional peripheral suture measured 61.7 5.0 N and 76.4 21.1 N. No significant difference was found between core suture types in gap resistance. No difference was found in maximum load to core suture failure among all groups. A statistically significant difference was found in maximum load to peripheral repair failure, which measured 57.8 12.2 N in conventional repairs and 74.2 20.4 N in barbed core repairs.

Conclusions: The addition of peripheral repair enhanced 2 mm gap resistance but not maximum core tensile strength in both conventional and barbed flexor tendon repairs. There may be a greater synergistic effect of peripheral repair with barbed over conventional core repairs. Barbed suture core repairs present a viable alternative to conventional repairs.

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