Document Detail


Effects of suture choice on biomechanics and physeal status after bioenhanced anterior cruciate ligament repair in skeletally immature patients: a large-animal study.
MedLine Citation:
PMID:  23200845     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: The objective of this study was to assess the effect of absorbable or nonabsorbable sutures in bioenhanced anterior cruciate ligament (ACL) repair in a skeletally immature pig model on suture tunnel and growth plate healing and biomechanical outcomes.
METHODS: Sixteen female skeletally immature Yorkshire pigs were randomly allocated to receive unilateral, bioenhanced ACL repair with an absorbable (Vicryl) or nonabsorbable (Ethibond) suture augmented by an extracellular matrix-based scaffold (MIACH). After 15 weeks of healing, micro-computed tomography was used to measure residual tunnel diameters and growth plate status, and biomechanical outcomes were assessed.
RESULTS: At 15 weeks postoperatively, there was a significant difference in tunnel diameter with significantly larger diameters in the nonabsorbable suture group (4.4 ± 0.3 mm; mean ± SD) than in the absorbable group (1.8 ± 0.5 mm; P < .001). The growth plate showed a significantly greater affected area in the nonabsorbable group (15.2 ± 3.4 mm(2)) than in the absorbable group (2.7 ± 0.8 mm(2), P < .001). There was no significant difference in the linear stiffness of the repairs (29.0 ± 14.8 N/mm for absorbable v 43.3 ± 28.3 N/mm for nonabsorbable sutures, P = .531), but load to failure was higher in the nonabsorbable suture group (211 ± 121.5 N) than in the absorbable suture group (173 ± 101.4 N, P = .002). There was no difference between the 2 groups in anteroposterior laxity at 30° (P = .5117), 60° (P = .3150), and 90° (P = .4297) of knee flexion.
CONCLUSIONS: The use of absorbable sutures for ACL repair resulted in decreased physeal plate damage after 15 weeks of healing; however, use of nonabsorbable sutures resulted in 20% stronger repairs.
CLINICAL RELEVANCE: Choice of suture type for ACL repair or repair of tibial avulsion fractures may depend on patient skeletal age and size, with absorbable sutures preferred in very young, small patients at higher risk with physeal damage and nonabsorbable sutures preferred in larger, prepubescent patients who may place higher loads on the repair.
Authors:
Patrick Vavken; Benedikt Proffen; Chris Peterson; Braden C Fleming; Jason T Machan; Martha M Murray
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Publication Detail:
Type:  Comparative Study; Evaluation Studies; Journal Article; Research Support, N.I.H., Extramural     Date:  2012-11-30
Journal Detail:
Title:  Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association     Volume:  29     ISSN:  1526-3231     ISO Abbreviation:  Arthroscopy     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-01-01     Completed Date:  2013-06-06     Revised Date:  2014-01-09    
Medline Journal Info:
Nlm Unique ID:  8506498     Medline TA:  Arthroscopy     Country:  United States    
Other Details:
Languages:  eng     Pagination:  122-32     Citation Subset:  IM    
Copyright Information:
Copyright © 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Absorbable Implants
Age Factors
Animals
Anterior Cruciate Ligament Reconstruction / methods*
Biomechanical Phenomena
Blood
Bone Density
Collagen
Equipment Failure
Female
Femur / physiopathology,  radiography,  surgery
Growth Plate / chemistry,  physiopathology*,  radiography,  surgery
Joint Instability / etiology
Materials Testing
Polyethylene Terephthalates*
Polyglactin 910*
Postoperative Complications / etiology
Random Allocation
Sus scrofa / growth & development
Sutures*
Swine
Tensile Strength
Tibia / physiopathology,  radiography,  surgery
Tissue Scaffolds*
Weight-Bearing
Wound Healing*
Grant Support
ID/Acronym/Agency:
R01 AR052772/AR/NIAMS NIH HHS; R01 AR054099/AR/NIAMS NIH HHS; R01 AR056834/AR/NIAMS NIH HHS; R01-AR052772/AR/NIAMS NIH HHS; R01-AR054099/AR/NIAMS NIH HHS; R01-AR056834/AR/NIAMS NIH HHS
Chemical
Reg. No./Substance:
0/Ethibond; 0/Polyethylene Terephthalates; 34346-01-5/Polyglactin 910; 9007-34-5/Collagen
Comments/Corrections

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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