Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2024 Feb 6:51:122-129.
doi: 10.1016/j.jor.2024.01.011. eCollection 2024 May.

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

Andres R Perez  1 , Carlo Coladonato  1 , Rahul Muchintala  1 , Nicholas Christopher  1 , John Matthews  1 , Fotios P Tjoumakaris  1 , Kevin B Freedman  1
Affiliations
Review

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

Andres R Perez et al. J Orthop. .

Abstract

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 Fiberwire™ to have the lowest elongation and 4 studies found No. 2 Ultrabraid™ to have the greatest. 12 studies reported Maximum load to failure was highest in No. 2 Fiberwire™, No. 2 Ultrabraid™, and FiberTape™ while No. 2 Ethibond ™ had the lowest in 5 studies. 3 of the 5 studies that evaluated No. 2 Fiberwire™ found it to have the highest stiffness. No. 2 Ethibond™, No. 2 Orthocord™, and No. 2 PDS™ were reported as the least stiff sutures in 2 studies each.

Conclusion: Fiberwire™, FiberTape™, and Ultrabraid™ demonstrated the highest load to failure while Ethibond™ consistently was the weakest. Fiberwire™ was found to have the lowest elongation while Ultrabraid™ had the highest. Fiberwire™ was also noted to be the stiffest while PDS, Ethibond™, and Orthocord™ 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.

Keywords: Biomechanics; Elongation; Maximum load; Stiffness; Suture.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
PRISMA 2020 flow diagram for new systematic reviews. This figure depicts how the final selection of articles were included for analysis.
See this image and copyright information in PMC

References

    1. Ahn J.H., Wang J.H., Lim H.C., et al. Double transosseous pull out suture technique for transection of posterior horn of medial meniscus. Arch Orthop Trauma Surg. 2009;129(3):387–392. doi: 10.1007/s00402-008-0639-1. - DOI - PubMed
    1. Jh A., Jh W., Jc Y., Hk N., Jh P. A pull out suture for transection of the posterior horn of the medial meniscus: using a posterior trans-septal portal. Knee Surg Sports Traumatol Arthrosc Off J ESSKA. 2007;15(12) doi: 10.1007/s00167-007-0310-3. - DOI - PubMed
    1. Forkel P., Petersen W. Posterior root tear fixation of the lateral meniscus combined with arthroscopic ACL double-bundle reconstruction: technical note of a transosseous fixation using the tibial PL tunnel. Arch Orthop Trauma Surg. 2012;132(3):387–391. doi: 10.1007/s00402-011-1429-8. - DOI - PubMed
    1. Forkel P., Herbort M., Schulze M., et al. Biomechanical consequences of a posterior root tear of the lateral meniscus: stabilizing effect of the meniscofemoral ligament. Arch Orthop Trauma Surg. 2013;133(5):621–626. doi: 10.1007/s00402-013-1716-7. - DOI - PubMed
    1. Harner C.D., Mauro C.S., Lesniak B.P., Romanowski J.R. Biomechanical consequences of a tear of the posterior root of the medial meniscus. Surgical technique. J Bone Joint Surg Am. 2009;91(Suppl 2):257–270. doi: 10.2106/JBJS.I.00500. - DOI - PubMed

LinkOut - more resources