A systematic review of the biomechanical properties of suture materials used in orthopaedics

Background: Soft tissue injuries are frequently repaired using various suture material. The ideal suture should have the biomechanical properties of low displacement, high maximum load to failure, and high stiffness to avoid deformation. Since tendon healing occurs over a period of months, it is important for the surgeon to select the proper suture with certain biomechanical properties. Therefore, the purpose of this study is to qualitative summarize the published literature on biomechanical properties of different suture materials used in orthopaedic procedures. Methods: Following PRISMA guidelines, PubMed and Cochrane databases were queried for original articles containing "biomechanic(s)" and "suture" keywords. Following screening for inclusion and exclusion, final articles were reviewed for relevant data and collected for qualitative analysis. Data collected from each study included the tissue type repaired, suture material, and biomechanical properties, such as elongation, maximum load to failure, stiffness, and method of failure. Results: 17 articles met final inclusion criteria. Two studies found No.2 FiberwireTM to have the lowest elongation and 4 studies found No. 2 UltrabraidTM to have the greatest. 12 studies reported Maximum load to failure was highest in No. 2 FiberwireTM, No. 2 UltrabraidTM, and FiberTapeTM while No. 2 Ethibond TM had the lowest in 5 studies. 3 of the 5 studies that evaluated No. 2 FiberwireTM found it to have the highest stiffness. No. 2 EthibondTM, No. 2 OrthocordTM, and No. 2 PDSTM were reported as the least stiff sutures in 2 studies each. Conclusion: FiberwireTM, FiberTapeTM, and UltrabraidTM demonstrated the highest load to failure while EthibondTM consistently was the weakest. FiberwireTM was found to have the lowest elongation while UltrabraidTM had the highest. FiberwireTM was also noted to be the stiffest while PDS, EthibondTM, and OrthocordTM were found to be the least stiff. Final treatment decisions on which suture to utilize to optimize repair integrity and healing are complex, and rarely solely dependent upon the biomechanical properties of the materials used. Level of evidence: Systematic Review, Level IV.