Radiofrequency and its effect on suture strength

The use of radiofrequency-based electrocautery for hemostasis and ablation within the subacromial space and glenohumeral joint can cause damage to suture material. Prior studies have focused on the mechanical properties of sutures including their ability to withstand abrasion. The purpose of this study was to determine the effect of electrical energy on the mechanical properties of 5 different brands of #2 suture used for arthroscopic shoulder repair: FiberWire (Arthrex Inc, Naples, Florida); Orthocord (DePuy Mitek, Norwood, Massachusetts); Hi-Fi (formally Herculine; Linvatec Corp, Largo, Florida); MaxBraid (Teleflex Medical, Research Triangle Park, North Carolina); and Ethibond (Ethicon, Inc, Somerville, New Jersey). A matched pair of human deltoid muscle submerged in buffered saline solution (pH 7.4) was used as a test medium. The suture strengths were tested in 3 different scenarios. The 3 groups were as follows: control group without electrical current, coagulation group with direct introduction of electrical current on a coagulate setting for 2 seconds, and a cutting group with direct introduction of electrical current on a cut setting for 2 seconds. Hi-Fi suture seemed to be the least susceptible to damage by direct electrocautery application. Orthocord suffered the greatest loss of strength of all materials tested. This study demonstrates that exposure to electrocautery damages and weakens suture. Great care should be taken when electrocautery is used during arthroscopic repairs to prevent suture failure and preserve repair integrity.