Comparative study of knot performance and ease of manipulation of monofilament and braided sutures for arthroscopic applications

Abstract

The primary objective of this study is to determine whether alternative monofilament sutures, such as poly (glycolidetrimethylenecarbonate-co-dioxanone) (Biosyn(R)) and polypropylene (Prolene(R)) or braided poly (ethylene terephthalate), i.e. polyester (Surgidac (R)), provide superior knot performance and equivalent ease of manipulation to the existing absorbable PDS(R) suture. An in vitro experiment was designed in which both Duncan and Snyder knotted loops were tied from four different suture materials: PDS(R), Biosyn(R), Prolene(R) and Surgidac (R), using a standard arthroscopic knot pusher (Sixth Finger) and an Arthrex(R) practice box. The ease of manipulation was evaluated by measuring the time required to tie the knots, and the knot performance was assessed by performing first a cyclic fatigue test, and then a tensile loop pull test to failure under saline using an Instron(R) Universal tester. Among the criteria for evaluating the mechanical performance of the knotted loop were the loop elongation at 30N of applied force, the force required to extend the loop by 6% (3mm), called the loop holding capacity, as well as the knot security and maximum elongation at failure. The results were analyzed statistically by two-way analysis of variance in order to identify significant differences between the dependent variables. (Abstract shortened by UMI.)