title: The Effect of Instrumentation on Suture Tensile Strength and Knot Pullout Strength of Common Suture Materials.
abstract: OBJECTIVE
  To determine the effect of instrumentation of suture material on knot security and tensile strength.
  
  
  METHODS
  In all, 5 types of suture material were used; 10 knots were tied without any instrumentation and 10 knots were tied with a hemostat holding tension on the first throw while the second throw was made for each suture type. Each group was tested to failure with the maximum load and mode of failure recorded. The maximum load between groups of each suture type was compared; frequency of failure through knot slippage vs material fracture was also compared between groups.
  
  
  RESULTS
  There was no significant difference observed in the maximum load to failure for any suture type between instrumented and noninstrumented groups. Additionally, there was no difference between any instrumented and noninstrumented groups for material failure vs failure due to knot slippage.
  
  
  CONCLUSIONS
  Instrumentation of suture material during two-hand tying does not affect the strength of suture material or knot security.
authors.affiliation: Department of Orthopaedic Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia; Department of Clinical Investigation, Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia. Electronic address: peter.c.johnson.mil@mail.mil.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Johnson
authors.affiliation: Department of Orthopaedic Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia; Department of Clinical Investigation, Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia.
authors.forename: Aaron D
authors.initials: AD
authors.lastname: Roberts
authors.affiliation: Department of Orthopaedic Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia; Department of Clinical Investigation, Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia.
authors.forename: Justin M
authors.initials: JM
authors.lastname: Hire
authors.affiliation: Department of Orthopaedic Surgery, Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia; Department of Clinical Investigation, Dwight D. Eisenhower Army Medical Center, Fort Gordon, Georgia.
authors.forename: Terry L
authors.initials: TL
authors.lastname: Mueller
mesh_terms: D008422:Materials Testing; D013536:Suture Techniques / Q000295:instrumentation*; D013537:Sutures; D013718:Tensile Strength
keywords: Medical Knowledge; Patient Care; Practice-Based Learning and Improvement; knot security; suture material; suture strength