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Does plastic suture deformation induce gapping after tendon repair? A biomechanical comparison of different suture materials.
J Biomech. 2016 09 06; 49(13):2607-2612.JB

Abstract

Plastic deformation of sutures creates an irreversible extension during load. To test our hypothesis that such plastic deformation causes gap formation after tendon repair, we determined the plasticity of five different suture materials commonly used in tendon surgery. Prolene, Polydioxanone (PDS), Ethibond, Vicryl, and FiberWire sutures were biomechanically tested to determine their offset yield strength, initial extension, creep, relaxed elongation, peak-to-peak displacement, stiffness, and maximum tensile strength under static, constant, and cyclic loading. In addition, 35 porcine hindlimb tendons were used to evaluate gap formation and the biomechanical behavior of the suture materials after tendon repair. Prolene had a low offset yield strength and high initial extensions at 30, 60, and 90N combined with relatively large creep, relaxed elongation, and peak-to-peak displacement. Aside from the low maximum tensile strength and stiffness, these parameters indicate an early plastic deformation during loading. The material properties of PDS were generally better for suturing than those of Prolene, but no difference was found in offset yield strength or initial extension. In contrast to the monofilament materials Prolene and PDS, the braided Ethibond, Vicryl, and FiberWire materials showed significantly less plastic deformation. The lowest amount of plastic deformation was found in the FiberWire and the results for Ethibond and Vicryl were equal. Gap formation occurred at the lowest tension force in the Prolene group, but only FiberWire required a significantly larger tension force to produce gapping at the repair site, indicating a higher resistance to gap formation. The results of this study show that plastic deformation occurs at a lower tension force in the monofilament sutures Prolene and PDS than in the braided materials Ethibond, Vicryl, and FiberWire. After tendon repair, FiberWire likely prevents gap formation, whereas Prolene induces gapping through low-tension plastic deformation. Therefore, plastic deformation should be considered when selecting suture materials for tendon repair surgery.

Authors+Show Affiliations

Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, Germany. Electronic address: Jordan_M@ukw.de.Department of Orthopaedic Surgery, The University of Würzburg, König Ludwig Haus, Brettreichstr. 11, 97074 Würzburg, Germany.Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, Germany.Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, Germany.Department of Orthopaedic Trauma, Hand, Plastic and Reconstructive Surgery, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, Germany.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27264620

Citation

Jordan, Martin C., et al. "Does Plastic Suture Deformation Induce Gapping After Tendon Repair? a Biomechanical Comparison of Different Suture Materials." Journal of Biomechanics, vol. 49, no. 13, 2016, pp. 2607-2612.
Jordan MC, Boelch S, Jansen H, et al. Does plastic suture deformation induce gapping after tendon repair? A biomechanical comparison of different suture materials. J Biomech. 2016;49(13):2607-2612.
Jordan, M. C., Boelch, S., Jansen, H., Meffert, R. H., & Hoelscher-Doht, S. (2016). Does plastic suture deformation induce gapping after tendon repair? A biomechanical comparison of different suture materials. Journal of Biomechanics, 49(13), 2607-2612. https://doi.org/10.1016/j.jbiomech.2016.05.023
Jordan MC, et al. Does Plastic Suture Deformation Induce Gapping After Tendon Repair? a Biomechanical Comparison of Different Suture Materials. J Biomech. 2016 09 6;49(13):2607-2612. PubMed PMID: 27264620.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Does plastic suture deformation induce gapping after tendon repair? A biomechanical comparison of different suture materials. AU - Jordan,Martin C, AU - Boelch,Sebastian, AU - Jansen,Hendrik, AU - Meffert,Rainer H, AU - Hoelscher-Doht,Stefanie, Y1 - 2016/05/25/ PY - 2016/02/15/received PY - 2016/05/17/revised PY - 2016/05/18/accepted PY - 2016/6/7/pubmed PY - 2017/9/7/medline PY - 2016/6/7/entrez KW - Achilles KW - Gap KW - Patella KW - Quadriceps KW - Repair KW - Suture KW - Tendon SP - 2607 EP - 2612 JF - Journal of biomechanics JO - J Biomech VL - 49 IS - 13 N2 - Plastic deformation of sutures creates an irreversible extension during load. To test our hypothesis that such plastic deformation causes gap formation after tendon repair, we determined the plasticity of five different suture materials commonly used in tendon surgery. Prolene, Polydioxanone (PDS), Ethibond, Vicryl, and FiberWire sutures were biomechanically tested to determine their offset yield strength, initial extension, creep, relaxed elongation, peak-to-peak displacement, stiffness, and maximum tensile strength under static, constant, and cyclic loading. In addition, 35 porcine hindlimb tendons were used to evaluate gap formation and the biomechanical behavior of the suture materials after tendon repair. Prolene had a low offset yield strength and high initial extensions at 30, 60, and 90N combined with relatively large creep, relaxed elongation, and peak-to-peak displacement. Aside from the low maximum tensile strength and stiffness, these parameters indicate an early plastic deformation during loading. The material properties of PDS were generally better for suturing than those of Prolene, but no difference was found in offset yield strength or initial extension. In contrast to the monofilament materials Prolene and PDS, the braided Ethibond, Vicryl, and FiberWire materials showed significantly less plastic deformation. The lowest amount of plastic deformation was found in the FiberWire and the results for Ethibond and Vicryl were equal. Gap formation occurred at the lowest tension force in the Prolene group, but only FiberWire required a significantly larger tension force to produce gapping at the repair site, indicating a higher resistance to gap formation. The results of this study show that plastic deformation occurs at a lower tension force in the monofilament sutures Prolene and PDS than in the braided materials Ethibond, Vicryl, and FiberWire. After tendon repair, FiberWire likely prevents gap formation, whereas Prolene induces gapping through low-tension plastic deformation. Therefore, plastic deformation should be considered when selecting suture materials for tendon repair surgery. SN - 1873-2380 UR - https://www.unboundmedicine.com/medline/citation/27264620/Does_plastic_suture_deformation_induce_gapping_after_tendon_repair_A_biomechanical_comparison_of_different_suture_materials_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0021-9290(16)30606-6 DB - PRIME DP - Unbound Medicine ER -