title: Risk of glove perforation with arthroscopic knot tying using different surgical gloves and high-tensile strength sutures.
abstract: OBJECTIVE
  To examine the risk of glove tears associated with arthroscopic knot tying using 4 commonly used high-tensile strength sutures and 2 different types of gloves.
  
  
  METHODS
  We analyzed 2 different surgical latex glove types (0.24-mm-thick powder-free and 0.32-mm-thick powdered) for perforation after arthroscopic knot tying with 4 different high-tensile strength sutures: Hi-Fi (ConMed Linvatec, Largo, FL), Ultrabraid (Smith & Nephew, Memphis, TN), FiberWire (Arthrex, Naples, FL), and Orthocord (DePuy Mitek, Raynham, MA). All knots were tied by a double-gloved single surgeon. Twelve trials of 4 knots each were performed for every glove-suture combination. All gloves were analyzed for perforation by a blinded evaluator using visual inspection, hydro-insufflation, and electroconductivity.
  
  
  RESULTS
  The overall incidence of glove perforation was 3.4% and was detectable only by the electroconductivity method; the other 2 methods did not detect any perforations. There was a statistically significantly higher rate (P < .001) of perforations in the 0.32-mm powdered gloves (6.8%) compared with the 0.24-mm powder-free gloves (0%). Perforation of the inner glove occurred 5.7 times more frequently than perforation of the outer glove. However, simultaneous perforation of both the inner and outer gloves did not occur in any set. The Hi-Fi suture was involved in 6 perforations compared with 4 for FiberWire, 3 for Ultrabraid, and 0 for Orthocord.
  
  
  CONCLUSIONS
  Double gloving provides an adequate surgical barrier between the surgeon and the patient during arthroscopic knot tying with high-tensile strength sutures as indicated by the low incidence of glove perforations in our study in an in vitro biomechanical evaluation. There were no instances of simultaneous perforation of both the inner and outer gloves. All perforations occurred only in the thicker (0.32-mm) powdered gloves.
  
  
  CONCLUSIONS
  Glove tears and finger lacerations have been reported with the use of high-tensile strength sutures during arthroscopic shoulder surgery, thereby raising a concern for safety and disease transmission. This study addresses these concerns by evaluating the risk of glove tears during arthroscopic knot tying.
authors.affiliation: Division of Orthopaedic Surgery, McGill University Health Centre, Montreal, Quebec, Canada.
authors.forename: Adriana
authors.initials: A
authors.lastname: Martinez
authors.forename: Yung
authors.initials: Y
authors.lastname: Han
authors.forename: Zeeshan M
authors.initials: ZM
authors.lastname: Sardar
authors.forename: Lorne
authors.initials: L
authors.lastname: Beckman
authors.forename: Thomas
authors.initials: T
authors.lastname: Steffen
authors.forename: Bruce S
authors.initials: BS
authors.lastname: Miller
authors.forename: Paul A
authors.initials: PA
authors.lastname: Martineau
mesh_terms: D001182:Arthroscopy / Q000379:methods; D019544:Equipment Failure Analysis / Q000379:methods*; D005932:Gloves, Surgical; D007840:Latex; D013536:Suture Techniques; D013537:Sutures / Q000009:adverse effects*; D013718:Tensile Strength
chemical_list: D007840:Latex