Arthroscopic Suture Material and Knot Type: An Updated Biomechanical Analysis
Background Several new arthroscopic suture materials are available. It is important for surgeons to know which suture-knot combination provides the strongest construct. Hypothesis The newer, polyblend sutures have dissimilar load-to-failure characteristics. Study Design Controlled laboratory study....
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| Veröffentlicht in: | The American journal of sports medicine 2009-08, Vol.37 (8), p.1578-1585 |
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| creator | Swan, Kenneth G. Baldini, Todd McCarty, Eric C. |
| description | Background
Several new arthroscopic suture materials are available. It is important for surgeons to know which suture-knot combination provides the strongest construct.
Hypothesis
The newer, polyblend sutures have dissimilar load-to-failure characteristics.
Study Design
Controlled laboratory study.
Methods
The load to failure of 4 knots was evaluated (surgeon's, Duncan loop, Samsung Medical Center [SMC], and Roeder) using 5 No. 2 suture materials (Ethibond, Ticron, FiberWire, ForceFiber, MaxBraid). One surgeon tied all knots. Fifteen samples were tested for each suture-knot configuration. Knots were pretensioned to 10 N, then loaded to failure at a rate of 1.0 mm/s. Failure load recorded was the maximum load applied between 0 and 3 mm of displacement. Cyclic loading of suture-knot samples was performed on 3 knots (surgeon's, Duncan loop, and SMC) using 4 suture materials (Ethibond, FiberWire, ForceFiber, MaxBraid). Six samples were tested for each suture-knot configuration. Knots were cyclically loaded from 5 to 40 N at 0.5 Hz for 1000 cycles, then loaded to failure. Data were compared with analysis of variance and the Tukey multiple range test and considered significant at P |
| doi_str_mv | 10.1177/0363546509332816 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_744582520</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sage_id>10.1177_0363546509332816</sage_id><sourcerecordid>1828829931</sourcerecordid><originalsourceid>FETCH-LOGICAL-c377t-8de27764836c0e880713bca9d766be952cf0d0d6e91240f3ac89d83ef196c30f3</originalsourceid><addsrcrecordid>eNp90M9LwzAUB_AgipvTuycpggpC9SVpfh3H8BdOPDjPJUtT7ejamrSH_femrCgM9BTI-7yXvC9CpxhuMBbiFiinLOEMFKVEYr6HxpgxElPK2T4a9-W4r4_QkfcrAMCCy0M0wioRoBI-RtdT13662pu6KUz01rWds9GLbq0rdBnpKoueq7qNFpvGHqODXJfengznBL3f3y1mj_H89eFpNp3HhgrRxjKzRAieSMoNWClBYLo0WmWC86VVjJgcMsi4VZgkkFNtpMoktTlW3NBwMUFX27mNq78669t0XXhjy1JXtu58KpKEScIIBHn5r-SCEQxEBXi-A1d156qwRUqwAKawIgHBFpmQh3c2TxtXrLXbpBjSPu50N-7QcjbM7ZZrm_02DPkGcDEA7Y0uc6crU_gfR7AEJVm_Sbx1Xn_Y38_9-fA3dOGQ2Q</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>217059192</pqid></control><display><type>article</type><title>Arthroscopic Suture Material and Knot Type: An Updated Biomechanical Analysis</title><source>MEDLINE</source><source>SAGE Complete A-Z List</source><source>Alma/SFX Local Collection</source><creator>Swan, Kenneth G. ; Baldini, Todd ; McCarty, Eric C.</creator><creatorcontrib>Swan, Kenneth G. ; Baldini, Todd ; McCarty, Eric C.</creatorcontrib><description>Background
Several new arthroscopic suture materials are available. It is important for surgeons to know which suture-knot combination provides the strongest construct.
Hypothesis
The newer, polyblend sutures have dissimilar load-to-failure characteristics.
Study Design
Controlled laboratory study.
Methods
The load to failure of 4 knots was evaluated (surgeon's, Duncan loop, Samsung Medical Center [SMC], and Roeder) using 5 No. 2 suture materials (Ethibond, Ticron, FiberWire, ForceFiber, MaxBraid). One surgeon tied all knots. Fifteen samples were tested for each suture-knot configuration. Knots were pretensioned to 10 N, then loaded to failure at a rate of 1.0 mm/s. Failure load recorded was the maximum load applied between 0 and 3 mm of displacement. Cyclic loading of suture-knot samples was performed on 3 knots (surgeon's, Duncan loop, and SMC) using 4 suture materials (Ethibond, FiberWire, ForceFiber, MaxBraid). Six samples were tested for each suture-knot configuration. Knots were cyclically loaded from 5 to 40 N at 0.5 Hz for 1000 cycles, then loaded to failure. Data were compared with analysis of variance and the Tukey multiple range test and considered significant at P <. 05.
Results
The surgeon's and SMC knots were strongest, particularly if tied using MaxBraid or ForceFiber. With single load-to-failure testing, MaxBraid was significantly stronger than Ethibond, Ticron, or FiberWire, regardless of knot type used. ForceFiber was stronger than Ethibond and Ticron with any knot type, and stronger than FiberWire when tied with a surgeon's knot or Roeder knot. The MaxBraid surgeon's knot (246 N) and MaxBraid SMC knot (239 N) were more than twice as strong as the Ethibond surgeon's knot (111 N) and Ethibond SMC (118 N). With cyclic loading, MaxBraid and ForceFiber were stronger than FiberWire and Ethibond, regardless of knot type tied. The SMC knot using MaxBraid withstood the highest load, and was stronger than the Duncan loop tied with MaxBraid. When stricter criteria (1-mm and 2-mm displacement) for failure were used, MaxBraid and ForceFiber remained superior to other sutures, including FiberWire, but knot type became less significant.
Conclusion
Nonabsorbable polyblend sutures are stronger than traditional sutures, but not all polyblend sutures are alike. MaxBraid and ForceFiber provide a stronger knot than FiberWire, Ethibond, and Ticron, particularly if tied using a surgeon's or SMC knot.
Clinical Relevance
The SMC knot using MaxBraid provides the strongest knot/suture combination of knots and sutures tested.</description><identifier>ISSN: 0363-5465</identifier><identifier>EISSN: 1552-3365</identifier><identifier>DOI: 10.1177/0363546509332816</identifier><identifier>PMID: 19470946</identifier><identifier>CODEN: AJSMDO</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Arthroscopy ; Biological and medical sciences ; Biomechanical Phenomena ; Biomechanics ; Biomechanics. Biorheology ; Diseases of the osteoarticular system ; Endoscopy ; Fundamental and applied biological sciences. Psychology ; Investigative techniques, diagnostic techniques (general aspects) ; Knots ; Load ; Materials Testing - methods ; Medical sciences ; Polymers ; Surgeons ; Suture Techniques ; Sutures ; Tissues, organs and organisms biophysics</subject><ispartof>The American journal of sports medicine, 2009-08, Vol.37 (8), p.1578-1585</ispartof><rights>2009 American Orthopaedic Society for Sports Medicine</rights><rights>2009 INIST-CNRS</rights><rights>Copyright Sage Publications Ltd. Aug 2009</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c377t-8de27764836c0e880713bca9d766be952cf0d0d6e91240f3ac89d83ef196c30f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/0363546509332816$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/0363546509332816$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,776,780,21799,27903,27904,43600,43601</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=21809850$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19470946$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Swan, Kenneth G.</creatorcontrib><creatorcontrib>Baldini, Todd</creatorcontrib><creatorcontrib>McCarty, Eric C.</creatorcontrib><title>Arthroscopic Suture Material and Knot Type: An Updated Biomechanical Analysis</title><title>The American journal of sports medicine</title><addtitle>Am J Sports Med</addtitle><description>Background
Several new arthroscopic suture materials are available. It is important for surgeons to know which suture-knot combination provides the strongest construct.
Hypothesis
The newer, polyblend sutures have dissimilar load-to-failure characteristics.
Study Design
Controlled laboratory study.
Methods
The load to failure of 4 knots was evaluated (surgeon's, Duncan loop, Samsung Medical Center [SMC], and Roeder) using 5 No. 2 suture materials (Ethibond, Ticron, FiberWire, ForceFiber, MaxBraid). One surgeon tied all knots. Fifteen samples were tested for each suture-knot configuration. Knots were pretensioned to 10 N, then loaded to failure at a rate of 1.0 mm/s. Failure load recorded was the maximum load applied between 0 and 3 mm of displacement. Cyclic loading of suture-knot samples was performed on 3 knots (surgeon's, Duncan loop, and SMC) using 4 suture materials (Ethibond, FiberWire, ForceFiber, MaxBraid). Six samples were tested for each suture-knot configuration. Knots were cyclically loaded from 5 to 40 N at 0.5 Hz for 1000 cycles, then loaded to failure. Data were compared with analysis of variance and the Tukey multiple range test and considered significant at P <. 05.
Results
The surgeon's and SMC knots were strongest, particularly if tied using MaxBraid or ForceFiber. With single load-to-failure testing, MaxBraid was significantly stronger than Ethibond, Ticron, or FiberWire, regardless of knot type used. ForceFiber was stronger than Ethibond and Ticron with any knot type, and stronger than FiberWire when tied with a surgeon's knot or Roeder knot. The MaxBraid surgeon's knot (246 N) and MaxBraid SMC knot (239 N) were more than twice as strong as the Ethibond surgeon's knot (111 N) and Ethibond SMC (118 N). With cyclic loading, MaxBraid and ForceFiber were stronger than FiberWire and Ethibond, regardless of knot type tied. The SMC knot using MaxBraid withstood the highest load, and was stronger than the Duncan loop tied with MaxBraid. When stricter criteria (1-mm and 2-mm displacement) for failure were used, MaxBraid and ForceFiber remained superior to other sutures, including FiberWire, but knot type became less significant.
Conclusion
Nonabsorbable polyblend sutures are stronger than traditional sutures, but not all polyblend sutures are alike. MaxBraid and ForceFiber provide a stronger knot than FiberWire, Ethibond, and Ticron, particularly if tied using a surgeon's or SMC knot.
Clinical Relevance
The SMC knot using MaxBraid provides the strongest knot/suture combination of knots and sutures tested.</description><subject>Arthroscopy</subject><subject>Biological and medical sciences</subject><subject>Biomechanical Phenomena</subject><subject>Biomechanics</subject><subject>Biomechanics. Biorheology</subject><subject>Diseases of the osteoarticular system</subject><subject>Endoscopy</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Knots</subject><subject>Load</subject><subject>Materials Testing - methods</subject><subject>Medical sciences</subject><subject>Polymers</subject><subject>Surgeons</subject><subject>Suture Techniques</subject><subject>Sutures</subject><subject>Tissues, organs and organisms biophysics</subject><issn>0363-5465</issn><issn>1552-3365</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp90M9LwzAUB_AgipvTuycpggpC9SVpfh3H8BdOPDjPJUtT7ejamrSH_femrCgM9BTI-7yXvC9CpxhuMBbiFiinLOEMFKVEYr6HxpgxElPK2T4a9-W4r4_QkfcrAMCCy0M0wioRoBI-RtdT13662pu6KUz01rWds9GLbq0rdBnpKoueq7qNFpvGHqODXJfengznBL3f3y1mj_H89eFpNp3HhgrRxjKzRAieSMoNWClBYLo0WmWC86VVjJgcMsi4VZgkkFNtpMoktTlW3NBwMUFX27mNq78669t0XXhjy1JXtu58KpKEScIIBHn5r-SCEQxEBXi-A1d156qwRUqwAKawIgHBFpmQh3c2TxtXrLXbpBjSPu50N-7QcjbM7ZZrm_02DPkGcDEA7Y0uc6crU_gfR7AEJVm_Sbx1Xn_Y38_9-fA3dOGQ2Q</recordid><startdate>20090801</startdate><enddate>20090801</enddate><creator>Swan, Kenneth G.</creator><creator>Baldini, Todd</creator><creator>McCarty, Eric C.</creator><general>SAGE Publications</general><general>Sage Publications</general><general>Sage Publications Ltd</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TS</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>7X8</scope></search><sort><creationdate>20090801</creationdate><title>Arthroscopic Suture Material and Knot Type</title><author>Swan, Kenneth G. ; Baldini, Todd ; McCarty, Eric C.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c377t-8de27764836c0e880713bca9d766be952cf0d0d6e91240f3ac89d83ef196c30f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Arthroscopy</topic><topic>Biological and medical sciences</topic><topic>Biomechanical Phenomena</topic><topic>Biomechanics</topic><topic>Biomechanics. Biorheology</topic><topic>Diseases of the osteoarticular system</topic><topic>Endoscopy</topic><topic>Fundamental and applied biological sciences. Psychology</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Knots</topic><topic>Load</topic><topic>Materials Testing - methods</topic><topic>Medical sciences</topic><topic>Polymers</topic><topic>Surgeons</topic><topic>Suture Techniques</topic><topic>Sutures</topic><topic>Tissues, organs and organisms biophysics</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Swan, Kenneth G.</creatorcontrib><creatorcontrib>Baldini, Todd</creatorcontrib><creatorcontrib>McCarty, Eric C.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Physical Education Index</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of sports medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Swan, Kenneth G.</au><au>Baldini, Todd</au><au>McCarty, Eric C.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Arthroscopic Suture Material and Knot Type: An Updated Biomechanical Analysis</atitle><jtitle>The American journal of sports medicine</jtitle><addtitle>Am J Sports Med</addtitle><date>2009-08-01</date><risdate>2009</risdate><volume>37</volume><issue>8</issue><spage>1578</spage><epage>1585</epage><pages>1578-1585</pages><issn>0363-5465</issn><eissn>1552-3365</eissn><coden>AJSMDO</coden><abstract>Background
Several new arthroscopic suture materials are available. It is important for surgeons to know which suture-knot combination provides the strongest construct.
Hypothesis
The newer, polyblend sutures have dissimilar load-to-failure characteristics.
Study Design
Controlled laboratory study.
Methods
The load to failure of 4 knots was evaluated (surgeon's, Duncan loop, Samsung Medical Center [SMC], and Roeder) using 5 No. 2 suture materials (Ethibond, Ticron, FiberWire, ForceFiber, MaxBraid). One surgeon tied all knots. Fifteen samples were tested for each suture-knot configuration. Knots were pretensioned to 10 N, then loaded to failure at a rate of 1.0 mm/s. Failure load recorded was the maximum load applied between 0 and 3 mm of displacement. Cyclic loading of suture-knot samples was performed on 3 knots (surgeon's, Duncan loop, and SMC) using 4 suture materials (Ethibond, FiberWire, ForceFiber, MaxBraid). Six samples were tested for each suture-knot configuration. Knots were cyclically loaded from 5 to 40 N at 0.5 Hz for 1000 cycles, then loaded to failure. Data were compared with analysis of variance and the Tukey multiple range test and considered significant at P <. 05.
Results
The surgeon's and SMC knots were strongest, particularly if tied using MaxBraid or ForceFiber. With single load-to-failure testing, MaxBraid was significantly stronger than Ethibond, Ticron, or FiberWire, regardless of knot type used. ForceFiber was stronger than Ethibond and Ticron with any knot type, and stronger than FiberWire when tied with a surgeon's knot or Roeder knot. The MaxBraid surgeon's knot (246 N) and MaxBraid SMC knot (239 N) were more than twice as strong as the Ethibond surgeon's knot (111 N) and Ethibond SMC (118 N). With cyclic loading, MaxBraid and ForceFiber were stronger than FiberWire and Ethibond, regardless of knot type tied. The SMC knot using MaxBraid withstood the highest load, and was stronger than the Duncan loop tied with MaxBraid. When stricter criteria (1-mm and 2-mm displacement) for failure were used, MaxBraid and ForceFiber remained superior to other sutures, including FiberWire, but knot type became less significant.
Conclusion
Nonabsorbable polyblend sutures are stronger than traditional sutures, but not all polyblend sutures are alike. MaxBraid and ForceFiber provide a stronger knot than FiberWire, Ethibond, and Ticron, particularly if tied using a surgeon's or SMC knot.
Clinical Relevance
The SMC knot using MaxBraid provides the strongest knot/suture combination of knots and sutures tested.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>19470946</pmid><doi>10.1177/0363546509332816</doi><tpages>8</tpages></addata></record> |
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| identifier | ISSN: 0363-5465 |
| ispartof | The American journal of sports medicine, 2009-08, Vol.37 (8), p.1578-1585 |
| issn | 0363-5465 1552-3365 |
| language | eng |
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| source | MEDLINE; SAGE Complete A-Z List; Alma/SFX Local Collection |
| subjects | Arthroscopy Biological and medical sciences Biomechanical Phenomena Biomechanics Biomechanics. Biorheology Diseases of the osteoarticular system Endoscopy Fundamental and applied biological sciences. Psychology Investigative techniques, diagnostic techniques (general aspects) Knots Load Materials Testing - methods Medical sciences Polymers Surgeons Suture Techniques Sutures Tissues, organs and organisms biophysics |
| title | Arthroscopic Suture Material and Knot Type: An Updated Biomechanical Analysis |
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