Inter- and intra-operator variability associated with extracapsular suture tensioning: an ex vivo study

Area of Science:

• Veterinary Orthopedics
• Surgical Techniques
• Biomechanical Analysis

Background:

• The lateral fabello-tibial suture is a common surgical technique for stabilizing the stifle joint in dogs.
• Accurate and consistent suture tension is crucial for successful outcomes in orthopedic procedures.

Purpose of the Study:

• To quantify the inter- and intra-operator variability in suture tensioning during lateral fabello-tibial suture placement.
• To assess the consistency of tension applied by different surgeons and by the same surgeon on separate occasions.

Main Methods:

• An ex vivo study utilizing fifteen Greyhound cadaveric pelvic limbs.
• The cranial cruciate ligament was transected, and a lateral fabello-tibial suture was placed.
• Three surgeons applied tension to the suture on two separate occasions, measuring tension at 135 degrees of stifle flexion using a calibrated tensiometer.

Main Results:

• Significant variability was observed in suture tensioning, both within individual surgeons (intra-operator) and between different surgeons (inter-operator).
• Intra-operator differences ranged from 0 to 14.7N, with 95% limits of agreement between -31.7N and 41.0N.
• Inter-operator differences ranged from 6.0 to 30.7N, with 95% limits of agreement between -25.6N and 62.5N.

Conclusions:

• There is marked variation in the tension applied during lateral fabello-tibial suture placement.
• This variability, both within and between surgeons, may contribute to inconsistent clinical outcomes in patients.
• Further research is needed to understand the clinical implications of this observed variation in suture tension.