The purpose of this study was to delineate the contribution of increasing suture strands and locking repair design in the prevention of gap formation using a cadaveric model for linear cyclical loading.
An increased number of core suture strands has been shown to increase the strength of suture repair models (Backus et al., 2017; Ortiz et al., 2012) but this has not been studied using the combined modified Bunnell and Kessler configuration.
High strength is achieved by employing locking suture loops to grip onto fibre bundles (Pennington 1979) and by increasing the number of suture strands crossing the defect (Savage 1985).
A small accessory portal was then made between the two sets of sutures (between strand locations 1, 2 and 3, 4) (Fig. 4a); this was 1 cm in length, and only the skin was incised.
Parikh et al. [5] compared, in cadaver flexor tendons, 3-strand and 6-strand barbed suture techniques to a knotted 4-strand cruciate technique, demonstrating that the 3-strand barbed suture achieved a breaking force comparable to that of 4-strand cruciate repair, but with significantly less repair site bunching.
Surgical suture is a strand of biocompatible material designed for wound closure, and therefore can be a medical device potentially suitable for local drug delivery to treat pain at the surgical site.
The favourable separation and failure characteristics of the 6-strand non-absorbable suture over the 8-strand absorbable suture shown in this study can, however, be applied to the management of Achilles tendon ruptures in patients.
Multi-strand suture techniques were developed to gain improved gap resistance and ultimate force compared with the respective two-strand techniques.
Thirty three percent of failure was due to knot failure and half of these (n = 2) occurred in the absorbable 8-strand suture.
When trying to critically analyze the literature, in each study one finds that the tendon repair technique, number of strands, suture material and suture diameter between control and experimental groups change, making it difficult to compare the results.
