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Inflammatory synovial fluid and absorbable suture strength.

F A Barber1, G S Gurwitz

  • 1Plano Orthopedic and Sports Medicine Center, TX 75075.

Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association
|January 1, 1988
PubMed
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For meniscus repair, absorbable sutures like polyglactin-910 (Vicryl) and polyglycolic-acid (Dexon) lose significant strength within 3 weeks. Nonabsorbable braided polyester sutures are recommended for optimal meniscal healing support.

Area of Science:

  • Orthopedic Surgery
  • Biomaterials Science
  • Biomedical Engineering

Background:

  • Meniscus repair is a common orthopedic procedure.
  • Suture material choice is critical for successful meniscus healing.
  • The inflammatory environment of the knee can affect suture degradation.

Purpose of the Study:

  • To evaluate the effect of inflammatory synovial fluid on the mechanical strength of commonly used absorbable sutures for meniscus repair.
  • To compare the degradation rates of various suture materials in an in vivo model.

Main Methods:

  • Lengths of polyglactin-910 (Vicryl), polyglycolic-acid (Dexon), chromic gut, polydioxanone (PDS), and braided polyester (Mersiline) sutures were implanted into arthritic rabbit knees.
  • Suture breaking strength was tested at intervals of 1-6 weeks post-implantation.

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Main Results:

  • Polyglactin-910 and polyglycolic-acid sutures retained minimal strength after 3 weeks.
  • Chromic gut sutures lost nearly all strength by 6 weeks.
  • Polydioxanone sutures showed accelerated degradation in inflammatory fluid, retaining only 40% strength at 5 weeks.
  • Braided polyester sutures maintained their original breaking strength throughout the 6-week study period.

Conclusions:

  • Only polydioxanone and braided polyester sutures retained significant strength at 6 weeks, a critical period for meniscus repair.
  • The degradation of absorbable sutures in an inflammatory joint environment is a significant concern.
  • Nonabsorbable suture materials appear to be a more appropriate choice for meniscus repair due to their sustained strength during the healing period.