Arthroscopic suture material and knot type: an updated biomechanical analysis

Area of Science:

• Orthopedic Surgery
• Biomaterials Science
• Surgical Techniques

Background:

• Advancements in arthroscopic surgery necessitate stronger suture materials.
• Understanding the load-to-failure characteristics of suture-knot constructs is crucial for surgical success.

Purpose of the Study:

• To evaluate the load-to-failure strength of various arthroscopic suture-knot combinations.
• To compare the performance of newer polyblend sutures against traditional materials.

Main Methods:

• A controlled laboratory study tested four knot types (surgeon's, Duncan loop, SMC, Roeder) with five No. 2 suture materials (Ethibond, Ticron, FiberWire, ForceFiber, MaxBraid).
• Load-to-failure testing and cyclic loading were performed to assess construct strength and durability.
• Statistical analysis (ANOVA, Tukey's test) determined significant differences (P < .05).

Main Results:

• MaxBraid and ForceFiber sutures, especially with surgeon's or SMC knots, demonstrated significantly higher load-to-failure strengths.
• The MaxBraid surgeon's knot (246 N) and SMC knot (239 N) were over twice as strong as Ethibond equivalents.
• Under cyclic loading, MaxBraid and ForceFiber maintained superior strength compared to FiberWire and Ethibond.

Conclusions:

• Newer polyblend sutures like MaxBraid and ForceFiber offer enhanced strength over traditional sutures.
• The surgeon's and SMC knots provide the strongest constructs when paired with MaxBraid or ForceFiber sutures.
• The MaxBraid suture with the SMC knot yielded the strongest overall knot/suture combination tested.