Contrast-Permeated Suture Tape in Orthopedic Practice: Imaging Characteristics and Mechanical Performance

Suture tapes are widely used in orthopedic procedures, providing superior tissue repair through higher tensile strength than traditional round sutures. Their broad, flat profile makes them especially well-suited for cerclage fixation, distributing pressure over a larger surface area and enhancing overall stability. Cerclage fixation remains a widely utilized technique in orthopedic practice, serving to reinforce structurally compromised tissue through circumferential mechanical support. Suture-based cerclage fixation has emerged as an alternative to traditional metal wires or cables for the management of periprosthetic fractures. However, a key limitation of suture-based cerclage fixation is its limited visibility on standard imaging modalities, which restricts both intraoperative verification and postoperative assessment. This technical report aimed to (1) report the feasibility of incorporating a commercially available iodine-based contrast medium into suture tape to render it radiopaque under fluoroscopy, and (2) assess the impact of this modification on the suture tape's key mechanical properties. Contrast-permeated suture tape was prepared using a standardized protocol to ensure reproducibility, consisting of one-minute immersion in an iodine-containing contrast medium, gentle manual wringing between two fingers to remove excess contrast, and approximately two minutes of air-drying under ambient laboratory conditions prior to testing. Standardized fluoroscopy was performed under identical exposure settings. Radiographic visibility of contrast-permeated (n = 4) and non-contrast-permeated (n = 4) suture tapes was assessed using a cadaveric model simulating an oblique mid-shaft humeral fracture under three applied tension conditions (no tension, 50% of maximum tension, and 75% of maximum tension). Visibility was assessed using a standardized ordinal grading scale. Mechanical properties of the suture tape in both groups (n = 12 per group) were assessed using dynamic creep and ultimate load-to-failure testing. Contrast-permeated suture tape was radiopaque under fluoroscopy across all tension levels, whereas non-contrast-permeated tape remained radiolucent. Dynamic creep displacement was 2.3 ± 0.6 mm for contrast-permeated suture tape and 2.1 ± 0.7 mm for non-contrast tape, with no statistically significant difference (p = 0.46). Ultimate load-to-failure was significantly higher for contrast-permeated tape (737 ± 46 N) compared with non-contrast tape (642 ± 59 N, p < 0.05). One possible explanation for the higher ultimate load-to-failure observed in the contrast-permeated group is that air exposure produced an adhesive effect in the iodine-based contrast medium, increasing inter-strand friction and reducing knot slippage, thereby enhancing ultimate failure strength. In conclusion, iodine-based contrast-permeated suture tape is clinically feasible and enhances fluoroscopic visibility without compromising mechanical performance. It offers a practical alternative to conventional sutures or suture tape constructs where clear intraoperative and postoperative visualization is essential.