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Newer polyethylene suture designs show greater strength over earlier suture types

When damaged, polyethylene core sutures withstood significantly higher loads before failing, compared to braided polyester and absorbable monofilament sutures.

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Hybrid polyethylene core sutures can withstand significantly greater biomechanical forces than older suture designs, including absorbable monofilament and braided polyester sutures, an in vitro study found.

Patrick B. Wright, MD, and colleagues at the Baylor College of Medicine in Houston evaluated the mechanical properties of both experimentally damaged and undamaged No. 2 sutures. The researchers focused on five sutures representative of the various suture classes, including the following:

• polydioxanone (PDS, Ethicon), and absorbable monofilament suture;
• Ethibond (Ethicon), a braided polyester suture;
• Tevdek (Deknatel), a braided polyester suture impregnated with polytetrafluoroethylene;
• Orthocord (Mitek, a division of Ethicon), a braided PDS core covered in a braided PDS-polyethylene sleeve; and
• FiberWire (Arthrex), an ultra-high molecular weight (UHMW) polyethylene core covered in a braided polyester jacket.

"[We] elected to test different classes of sutures, along with two new sutures that are representative of the hybrid class, to gain insight into the biomechanical differences between various suture classes," the authors said.

Both damaged and undamaged sutures were tested to determine ultimate tensile strength (UTS) and load to failure (LTF). Suture damage was created by cutting approximately 20% of the suture width using a razor blade applied through a custom-made jig "to simulate damage incurred at the anchor site during surgical procedures," the authors said. No significant differences in the percentage of suture cut were noted between suture types, ranging from 17.7% to 22.5%, they added.

The researchers found that undamaged FiberWire sutures had the highest LTF and UTS overall. For undamaged FiberWire sutures, LTF averaged 255.3 N and UTS averaged 803.3 Mpa. Orthocord sutures performed second best, with an average LTF of 214.22 N and an average UTS of 642.22 Mpa, according to the study.

Cutting caused a significant decrease in LTF for all suture types (P<.00001), with PDS sutures showing the greatest loss of both LTF and UTS. However, both FiberWire and Orthocord again had significantly higher mean LTF and UTS when cut. For damaged FiberWire sutures, LTF averaged 166.52 N and UTS averaged 585.14 Mpa. For damaged Orthocord sutures, LTF averaged 148.88 N and UTS averaged 582.07 Mpa, according to the study.

Undamaged PDS sutures (pulled through an Arthrex anchor) and FiberWire sutures had the highest failure stresses (P<.05), averaging 1,110.5 Mpa for PDS sutures and 1,033.08 Mpa for FiberWire sutures. But, when damaged, FiberWire and Orthocord sutures showed the highest failure stresses, which averaged 1,208.87 Mpa for FiberWire sutures and 1,061.27 Mpa for Orthocord sutures, according to the study.

For more information:

• Wright PB, Budoff JE, Yeh ML, et al. Strength of damaged suture: An in vitro study. Arthroscopy. 2006;22:1270-1275.