title: Barbed suture tenorrhaphy: an ex vivo biomechanical analysis.
abstract: BACKGROUND
  Using barbed suture for flexor tenorrhaphy could permit knotless repair with tendon-barb adherence along the suture's entire length. The purpose of this study was to evaluate the tensile strength and repair-site profile of a technique of barbed suture tenorrhaphy.
  
  
  METHODS
  Thirty-eight cadaveric flexor digitorum profundus tendons were randomized to polypropylene barbed suture repair in a knotless three-strand or six-strand configuration, or to unbarbed four-strand cruciate repair. For each repair, the authors recorded the repair site cross-sectional area before and after tenorrhaphy. Tendons were distracted to failure, and data regarding load at failure and mode of failure were recorded.
  
  
  RESULTS
  The mean cross-sectional area ratio of control repairs was 1.5 +/- 0.3, whereas that of three-strand and six-strand barbed repairs was 1.2 +/- 0.2 (p = 0.009) and 1.2 +/- 0.1 (p = 0.005), respectively. Mean load to failure of control repairs was 29 +/- 7 N, whereas that of three-strand and six-strand barbed repairs was 36 +/- 7 N (p = 0.32) and 88 +/- 4 N (p < 0.001), respectively. All cruciate repairs failed by knot rupture or suture pullout, whereas barbed repairs failed by suture breakage in 13 of 14 repairs (p < 0.001).
  
  
  CONCLUSIONS
  In an ex vivo model of flexor tenorrhaphy, a three-strand barbed suture technique achieved tensile strength comparable to that of four-strand cruciate repairs and demonstrated significantly less repair-site bunching. A six-strand barbed suture technique demonstrated increased tensile strength compared with four-strand cruciate controls and significantly less repair-site bunching. Barbed suture repair may offer several advantages in flexor tenorrhaphy, and further in vivo testing is warranted.
authors.affiliation: Washington, D.C.; and Baltimore, Md. From the Department of Plastic Surgery, Georgetown University Hospital, and the Curtis National Hand Center, Union Memorial Hospital.
authors.forename: Pranay M
authors.initials: PM
authors.lastname: Parikh
authors.forename: Steven P
authors.initials: SP
authors.lastname: Davison
authors.forename: James P
authors.initials: JP
authors.lastname: Higgins
mesh_terms: D001696:Biomechanical Phenomena; D002102:Cadaver; D005383:Finger Injuries / Q000601:surgery; D006801:Humans; D011897:Random Allocation; D012107:Research Design; D013536:Suture Techniques; D013537:Sutures; D013708:Tendon Injuries / Q000601:surgery; D013710:Tendons / Q000601:surgery*; D013718:Tensile Strength