Inflammatory synovial fluid and absorbable suture strength.
The effect of inflammatory synovial fluid upon several absorbable sutures commonly used for meniscus repair was studied by implanting lengths of these sutures into unstable, arthritic rabbit knees and, after varying lengths of time (1-6 weeks), testing their breaking strength. Both polyglactin-910 (Vicryl) and polyglycolic-acid (Dexon) sutures retained only minimal breaking strength 3 weeks after implantation. Chromic gut sutures demonstrated a steady reduction in breaking strength until they retained only 6% of their original strength at 5 weeks and none at 6 weeks. Polydioxanone (PDS) sutures began to lose breaking strength at 2 weeks and retained only 40% of their original strength 5 weeks after implantation. The rate of loss in polydioxanone breaking strength was faster in inflammatory synovial fluid than previously reported in the normal synovial joint. Braided polyester sutures (Mersiline) showed no loss of breaking strength over the duration of this test. While the choice of suture is only one variable influencing the outcome of a meniscus repair, this study demonstrates that only polydioxanone and green braided polyester sutures retain any strength 6 weeks after implantation (the time of immobilization commonly recommended for meniscal repairs). Complete meniscal healing can require several months. In the absence of compelling evidence to the contrary, the use of nonabsorbable suture materials for meniscal repair seems the most appropriate choice.
Barber
F A
FA
Plano Orthopedic and Sports Medicine Center, TX 75075.
Gurwitz
G S
GS
D000042:Absorption; D000818:Animals; D007249:Inflammation; D008592:Menisci, Tibial / Q000601:surgery*; D011817:Rabbits; D013537:Sutures / Q000592:standards*; D013582:Synovial Fluid; D013585:Synovitis / Q000601:surgery*; D013718:Tensile Strength