Suture materials and suture techniques used in tendon repair

Area of Science:

• Orthopedic Surgery
• Biomaterials Science
• Tissue Engineering

Background:

• Immediately after tendon repair, the suture material and technique provide all the strength.
• Stainless steel sutures are strong but difficult to handle and create bulky knots.
• Absorbable sutures lose strength too quickly, while nonabsorbable synthetic fibers offer a balance of strength and usability.

Purpose of the Study:

• To evaluate the impact of suture materials and techniques on early and long-term tendon repair strength.
• To identify optimal suture techniques for different anatomical locations (hand, wrist, forearm).
• To understand the role of post-operative management in tendon healing and strength restoration.

Main Methods:

• Review of biomechanical properties of various suture materials (stainless steel, synthetic nonabsorbable, absorbable).
• Analysis of different suture techniques (lateral trap, end-weave, Bunnell, Kessler, Mason-Allen) regarding strength and tissue trauma.
• Discussion of the importance of post-operative splinting and controlled motion protocols.

Main Results:

• Nonabsorbable synthetic fibers (e.g., Supramid, Prolene) are currently most desirable.
• Lateral trap and end-weave techniques offer the strongest repairs but have limitations in specific anatomical areas.
• Less traumatic techniques (e.g., Kessler, Mason-Allen) in the hand/fingers promote faster healing and minimize complications like tendomalacia.

Conclusions:

• Suture material and technique selection significantly influences initial repair strength and healing potential.
• Minimally traumatic suture techniques combined with appropriate splinting and controlled motion facilitate optimal tendon healing.
• Tendon healing becomes the primary source of strength between three to six weeks post-repair, emphasizing the importance of gentle handling.