Two-month longitudinal study of mechanical properties of absorbable sutures used in orthopedic surgery
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RESEARCH ARTICLE
Open Access
Two-month longitudinal study of mechanical properties of absorbable sutures used in orthopedic surgery Daniel A Müller*, Jess G Snedeker and Dominik C Meyer
Abstract Background: This is the first study assessing the properties of large-diameter degradable sutures relevant for orthopedic applications over the course of in vitro incubation for 2 months. The data we present here provide guidance to the orthopedic surgeon in predicting the long-term performance of suture materials used everyday in surgical practice. Methods: Five different absorbable (Vicryl, Maxon, Monocryl, PDS II, Vicryl rapide) and one non-absorbable (Ethibond) suture materials were tested. Measurements were made at five time points during the 56 days of incubation under physiological conditions (37.0 ± 0.02 °C; pH 7.4 ± 0.2). The following variables were recorded: load to failure, strain at maximal load as elongation normalized to original length, stiffness as the ratio of load to displacement on the linear proportion of the stress strain curve, and hysteresis as area under the curve of the stress strain curve. Results: Vicryl was the strongest fiber on day 0 (195 N); however, by day 42, the tensile strength of the suture reduced to 14 N. Between days 14 and 28, PDS II (171 N) and Maxon (182 N) sustained the highest loads. Monocryl (p = 0.003) and Maxon (p < 0.001) showed an increasing strain with time, whereas Vicryl (p = 0.002) and Vicryl rapide (p = 0.007) revealed an increasing material stiffness. Furthermore, both Vicryl (p = 0.053) and Monocryl (p < 0.001) had an increasing hysteresis with ongoing degradation. Maxon, PDS II, and Ethibond showed stable material properties during the 2 months. Conclusions: The three absorbable sutures Vicryl, PDS II, and Maxon could sustain higher loads during the first 2 weeks than the non-absorbable Ethibond. Unexpectedly, Maxon and PDS II maintained their elastic properties in spite of their proceeding degradation and loss of tensile strength. Keywords: Suture, Absorbable fiber, Material properties, Degradation, In vitro, Orthopedic surgery
Background Medical suture material is essential to appropriately position and hold tissue until healing has occurred. Particularly in orthopedic surgery, the suture material may be subjected to considerable mechanical loads for a long time period, as healing after tendon, ligament, or fascia repair takes place over two or more postoperative months. Because the suture is often no longer needed after healing, different biodegradable suture materials have * Correspondence: [email protected] Department of Orthopedics, University Hospital Balgrist, Forchstrasse 340, 8008 Zürich, Switzerland
been developed and are in widespread surgical use. The materials used in such sutures can differ not only in tensile properties like strength and stiffness but also in knot strength. Data on longitudinal retention of mechanical strength is usually available over a limited time frame from the suture manufacturer. Yet, a thorough description of the s
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