The Properties of Damaged and Undamaged Suture Used in

Metal and Bioabsorbable Anchors: An In Vitro Study

Patrick B. Wright, M.D., Jeffrey E. Budoff, M.D., Ming Long Yeh, Ph.D., Zachary S. Kelm,
and Zong-Ping Luo, Ph.D.

Purpose: The purpose of this study was to determine the mechanical properties of undamaged and
damaged sutures in metal and bioabsorbable suture anchors. Methods: Undamaged and damaged
FiberWire (Arthrex, Naples, FL), Tevdek (Deknatel, Mansfield, MA), and PDS (Ethicon, Somerville,
NJ) sutures were tested by a single pull to failure while being pulled parallel to the axis of either a
metal or bioabsorbable suture anchor. Sutures were damaged by use of a razor blade incorporated into
a custom-designed jig. The friction of the sutures through the anchor eyelets was also tested. Results:
For both anchor types, FiberWire was the strongest suture studied. Undamaged PDS had a signifi-
cantly greater load to failure than Tevdek. Although all sutures lost significant strength when
damaged, PDS lost the most, with damaged PDS becoming significantly weaker than damaged
Tevdek. Damaged FiberWire was significantly stronger in metal anchors compared with bioabsorb-
able anchors, with failure of the bioabsorbable suture eyelet preventing testing of undamaged
FiberWire. Neither undamaged nor damaged PDS or Tevdek had a significant difference in strength
between metal and bioabsorbable anchors. However, in metal anchors the mechanical properties of
undamaged Tevdek were inferior to those of the other undamaged sutures tested. For undamaged or
damaged sutures through either anchor type, PDS suture had the highest coefficient of friction,
significantly higher than FiberWire and Tevdek. All sutures, undamaged or damaged, had signifi-
cantly less friction in bioabsorbable anchors compared with metal anchors. Conclusions: The
FiberWire-anchor construct is significantly weaker when bioabsorbable anchors are used instead of
metal anchors. For Tevdek and PDS sutures, the anchor type does not affect the strength of the
construct, as the suture is the limiting factor. When used with suture anchors, PDS has the most
friction of the sutures tested, potentially leading to suture damage, which disproportionately weakens
PDS compared with the other sutures tested. For both undamaged and damaged sutures, bioabsorb-
able anchors lead to less friction than do metal anchors, which may lessen suture damage in vivo.
Clinical Relevance: The mechanical properties of damaged suture are important to all surgeons who
use suture arthroscopically. Key Words: Suture—Damage—Biomechanics—Suture anchor.

S utures are an integral part of arthroscopic shoulder

repairs and reconstructions. Especially in the
shoulder, they are routinely passed through and along-
From the Department of Orthopaedic Surgery, Baylor College of
Medicine, Houston, Texas, U.S.A.
The authors report no conflict of interest.
Address correspondence and reprint requests to Jeffrey E.
Budoff, M.D., Department of Orthopaedic Surgery, Baylor College
of Medicine, 6620 Main St, Suite 1300, Houston, TX 77030, U.S.A.
E-mail: Jebudoff@yahoo.com
© 2007 by the Arthroscopy Association of North America
0749-8063/07/2306-6357$32.00/0
doi:10.1016/j.arthro.2007.01.008
side sharp instruments that may damage them. In
addition, they are routinely used in conjunction with
suture anchors, which may be composed of either
metal or a bioabsorbable polymer. The in vivo envi-
ronment exposes the suture to cyclic loading and
abrasion against the anchor’s eyelet during arthro-
scopic knot tying and during early postoperative re-
habilitation.1 The properties of damaged suture have
been examined.2 The influence of the type of anchor
on suture/anchor friction, which is a factor in the
occurrence and propagation of suture damage, as well
as on the mechanical properties of the suture once
damaged, is important for the arthroscopic surgeon to

Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 23, No 6 (June), 2007: pp 655-661 655
656 P. B. WRIGHT ET AL.
be aware of when deciding on his or her choice of
suture or anchor. The purpose of this study was to
determine the mechanical properties of undamaged
and damaged sutures in metal and bioabsorbable su-
ture anchors. The null hypothesis is that there is no
significant difference in mechanical properties for any
of the conditions tested.
METHODS
Three types of suture were tested: Tevdek (Deknatel,
Mansfield, MA), FiberWire (Arthrex, Naples, FL),
and PDS (Ethicon, Somerville, NJ). The anchors used
were the metal Arthrex 5.0-mm Corkscrew and the
bioabsorbable Arthrex 5.0-mm Bio-Corkscrew. Simi-
lar to other studies,2,3 preliminary testing did not show
differences in failure behavior between dry and wet
suture material. Therefore, to be consistent with pre-
vious studies,1-5 testing of all sutures was performed
dry at room temperature. The manufacturers have
indicated that the difference between room and body
temperature would be too small to make a significant
difference in the biomechanical properties of the su-
tures.
Twenty-four sutures of each type were used for the
load-to-failure/failure stress test; 12 were used with
metal anchors and 12 with bioabsorbable anchors.
Each of these groups was subdivided into 6 sutures to
be tested undamaged and 6 to be tested damaged. To
simulate potential damage incurred at the anchor site
during surgical procedures, sutures were then dam-
aged by cutting approximately 33% of their width
with a razor blade placed in a custom jig. This per-
centage of suture damage was chosen after a pilot
study so that the newer polyethylene suture
(FiberWire) could be tested in bioabsorbable anchors
without routinely destroying the anchor’s eyelet. The
goal was to minimize anchor breakage as a confound-
ing factor. The total width of the suture and the cut
depth were measured by use of a light microscope
attached to an electric micrometer to determine total
remaining cross-sectional area.
For all tests, the suture anchors were clamped be-
tween the flanges of a vise. The suture was passed
through the suture anchor eyelet. The free ends of the
suture were wound around a metallic hook to avoid
weakening the suture with knot tying. For single-pull,
load-to-failure testing, the load was applied to both
free ends of the suture parallel to the axis of the anchor
insertion, as in the U test2,3 (Fig 1). For tests involving
damaged suture, the damaged area was placed against
the superior rim of the anchor loop, facing away from
FIGURE 1. Diagram of suture anchor U test. (Reprinted with
permission.3)
it, toward the center of the eyelet. All tests were
performed at a displacement rate of 60 mm/min on an
MTS 858 Bionix machine (MTS, Eden Prairie, MN).
The anchor was rotated 180° after each test to reduce
any error resulting from manufacturing variance. Any
damaged anchors were discarded. Any test that re-
sulted in anchor failure was discarded so that only data
where suture strength was the limiting factor were
analyzed. The load to failure (LTF) was recorded as
the maximal load.
Technically, the term ultimate tensile stress is only
used for tests that solely measure material properties,
such as the straight-line pull test, and this term is
technically incorrect for a test involving an interaction
with another object (i.e., a suture anchor). Therefore,
for the tensile failure test, we use the term failure
stress (FS) to denote the material property of the
suture, as well as its interaction with the suture eyelet.
FS was calculated as LTF divided by cross-sectional
area, which had the decreased area corrected for in
damaged sutures. Because the purpose of this study is
to evaluate the biomechanical properties of suture and
not the anchor, only trials that failed because of suture
breakage were included in the analysis.
The friction of damaged and undamaged sutures
was measured while being pulled through a suture
anchor eyelet at a 45° angle, a different angle than was
used for the LTF suture anchor test. An additional 24
sutures of each type were used for the friction test; 12
 SUTURES AND METAL AND BIOABSORBABLE ANCHORS 657

recorded on a computer. The quotient of Fa/Fp

(Fig 2) is an indicator for the frictional resistance of
the suture in the anchor eyelet. Without friction, Fp
would be equal to Fa, and the quotient (Fa/Fp) would
equal 1.3 A pilot study confirmed that suture pulled
straight through a suture anchor had mechanical
properties similar to suture without an anchor
pulled to failure.
One-way analysis of variance with the post hoc
Tukey test was used to test the differences among the
sutures. The Student t test was used to compare cut
versus uncut sutures and metal versus bioabsorbable
anchors for each kind of suture. The difference was
considered significant at P ⬍ .05.

RESULTS
Suture Characteristics
Despite the fact that all sutures tested were No. 2
sutures, their cross-sectional areas varied. The cross-
FIGURE 2. Photograph of suture anchor U test. The body of the sectional area of uncut Tevdek was 0.26 ⫾ 0.03 mm2,
suture anchor is securely clamped between the flanges of a vise that of uncut PDS was 0.29 ⫾ 0.02 mm2, and that of
in such a way as to avoid damaging the anchor or altering the uncut FiberWire was 0.39 ⫾ 0.12 mm2, significantly
eyelet.
greater than both Tevdek and PDS (P ⬍ .05). The
percentage of suture cut for each test was very repro-
ducible within 3.1%, ranging from 33.50% to 36.60%.
were used with metal anchors and 12 with bioabsorb-
able anchors. Each of these groups was subdivided
into 6 sutures to be tested undamaged and 6 to be
tested damaged. The bodies of the suture anchors were
securely clamped between the flanges of a vise in such
a way as to avoid damaging the anchor or altering the
eyelet (Fig 2). The technique has been previously
described.2,3 The sutures were attached to an MTS
machine’s cross-head by use of Capstan grips, with a
passive load cell (range, 0 to 1,000 N). All tests were
performed at a displacement rate of 60 mm/min. One
suture branch was passed through the anchor eyelet
and pulled straight in line with the suture anchor axis
by an MTS machine, and the force at failure (Fa) was
recorded. The resulting force on the second suture
branch with an angle of 45° to the suture anchor axis
(Fp) was measured simultaneously by use of a second
electronic load cell (Fig 3).
For damaged sutures, the cut area was placed on the
suture branch held at 45° from the suture anchor axis,
1 cm from the anchor eyelet, facing toward the supe-
rior rim of the anchor loop, to ensure that the damaged
area would pass against the anchor loop. Loads were
FIGURE 3. Diagram of friction test. The testing machine pulls one
electronically transformed to an analog voltage de- branch (Fa, active) while the tensile load on the second branch (Fp,
vice, processed by an analog/digital converter, and passive) is recorded simultaneously. (Reprinted with permission.3)
658 P. B. WRIGHT ET AL.
Tensile Strength Testing
The results for LTF and FS of cut and uncut sutures
through metal and bioabsorbable anchors are summa-
rized in Table 1. For undamaged sutures through a
metal anchor, FiberWire had the highest LTF, signif-
icantly higher than the other sutures (P ⫽ .01). Un-
damaged FiberWire could not be evaluated with bio-
absorbable anchors, because it consistently destroyed
the anchors. Damaged FiberWire broke 2 bioabsorb-
able anchor eyelets; the results of these trials were
excluded from data analysis. Neither Tevdek nor PDS
resulted in any anchor failures. The eyelets of the
bioabsorbable anchors routinely broke at the top.
There was no evidence of anchor slippage from the
vise during testing.
For damaged sutures with either metal or bioabsorb-
able anchors, FiberWire had the highest LTF, signif-
icantly stronger than the other sutures (P ⫽ .0001).
Failure routinely occurred at the cut in the suture.
Undamaged sutures also failed at the eyelet, at the
“kink” in the suture caused by the eyelet.
For both metal and bioabsorbable anchors, undam-
aged PDS had a significantly greater LTF than Tevdek
(P ⫽ .0004 for metal anchors and P ⫽ .01 for bioab-
sorbable anchors). PDS lost a significant amount of
LTF when damaged and became significantly weaker
than damaged Tevdek (P ⫽ .00001 for metal anchors
and P ⫽ .00001 for bioabsorbable anchors).
For undamaged sutures with a metal anchor,
FiberWire and PDS both had a significantly greater FS
than Tevdek (P ⫽ .01). There was no significant
TABLE 1. LTF and FS of Cut and Uncut Tevdek, PDS, and FiberWire in Metal and Bioabsorbable Anchors
Tevdek
LTF (N)
Undamaged suture
Metal anchor 202.80 ⫾ 7.70
Bioabsorbable anchor 200.68 ⫾ 17.39
Damaged suture
Metal anchor 135.02 ⫾ 10.67
Bioabsorbable anchor 138.41 ⫾ 22.54
FS (MPa)
Undamaged suture
Metal anchor 833.94 ⫾ 21.65 1,110.50 ⫾ 193.26
Bioabsorbable anchor 916.57 ⫾ 150.25 1,028.36 ⫾ 223.21
Damaged suture
Metal anchor 837.46 ⫾ 57.45
Bioabsorbable anchor 1,011.94 ⫾ 262.43
NOTE. A “greater than” sign indicates significantly greater, whereas an “equals” sign indicates that there is no significant difference
between the two sutures’ values.
Abbreviation: NA, not applicable.
difference in the FS between undamaged FiberWire
and PDS. We could not evaluate undamaged
FiberWire using a bioabsorbable anchor, because it
consistently destroyed the anchors. There was no sig-
nificant difference between the FS of undamaged PDS
and Tevdek (P ⫽ .38).
As for LTF, when damaged, PDS lost a significantly
greater amount of FS than the other sutures. For
damaged sutures with either anchor, PDS had a
significantly lower FS than FiberWire and Tevdek
(P ⫽ .00001). For metal anchors, damaged FiberWire
had a significantly higher FS than damaged Tevdek
(P ⫽ .0007). For bioabsorbable anchors, there was no
significant difference between the FS of damaged
FiberWire and damaged Tevdek.
Damaged FiberWire had a significantly higher LTF
(P ⫽ .004) and FS (P ⫽ .009) with metal anchors
compared with bioabsorbable anchors. Again, undam-
aged FiberWire could not be tested with bioabsorbable
anchors. Neither undamaged nor damaged PDS or
Tevdek had a significant difference in strength (LTF
or FS) between metal and bioabsorbable anchors
(P ⬎ .05).
For both types of anchors, the LTF was signifi-
cantly lower for both damaged Tevdek and PDS
(P ⫽ .004) compared with undamaged sutures. For
metal anchors, the LTF of undamaged FiberWire
was significantly greater than the LTF of damaged
FiberWire (P ⫽ .0001). As previously mentioned,
undamaged FiberWire could not be tested with bio-
absorbable anchors. However, this suggests that the
PDS FiberWire Significance
248.37 ⫾ 16.00 365.88 ⫾ 15.57 FW ⬎ PDS ⬎ Tevdek
240.72 ⫾ 21.24 NA PDS ⬎ Tevdek
55.08 ⫾ 2.77 262.88 ⫾ 30.35 FW ⬎ Tevdek ⬎ PDS
53.45 ⫾ 5.16 218.63 ⫾ 8.93 FW ⬎ Tevdek ⬎ PDS
1,033.08 ⫾ 109.83 FW ⫽ PDS ⬎ Tevdek
NA PDS ⫽ Tevdek
376.04 ⫾ 100.13 1,208.87 ⫾ 164.87 FW ⬎ Tevdek ⬎ PDS
359.44 ⫾ 100.37 839.27 ⫾ 118.08 FW ⫽ Tevdek ⬎ PDS
 SUTURES AND METAL AND BIOABSORBABLE ANCHORS
same relationship holds true, because the bioabsorb-
able anchor’s eyelet was strong enough to allow
testing of 6 of 8 damaged FiberWire sutures but no
undamaged FiberWire sutures.
For metal anchors, there was no significant differ-
ence in FS for FiberWire and Tevdek between undam-
aged and damaged sutures (P ⬎ .05). For bioabsorb-
able anchors, Tevdek had no significant change in FS
when damaged (P ⬎ .05). Damaged PDS had a sig-
nificantly lower FS compared with undamaged PDS
for both metal (P ⫽ .0001) and bioabsorbable anchors
(P ⫽ .002).
Friction Testing
The results of friction through the anchor are sum-
marized in Table 2. For undamaged sutures through
either a metal or bioabsorbable anchor, PDS suture
had the highest coefficient of friction, significantly
higher than the other sutures (P ⫽ .0003). There was
no significant difference in friction between undam-
aged Tevdek and FiberWire through either type of
anchor (P ⫽ .44).
For damaged sutures through either anchor, PDS
suture again had the highest coefficient of friction,
significantly greater than the other sutures (P ⫽ .0001
for metal anchors and P ⫽ .0003 for bioabsorbable
anchors). Damaged FiberWire had significantly
greater friction than damaged Tevdek with metal an-
chors (P ⫽ .004), but there was no significant differ-
ence between these 2 sutures with bioabsorbable an-
chors.
All sutures, damaged and undamaged, had signifi-
cantly less friction in bioabsorbable anchors compared
with metal anchors (P ⫽ .028 for undamaged suture,
P ⫽ .0016 for damaged FiberWire and PDS, and P ⫽
.05 for damaged Tevdek). When being pulled through
a metal anchor, FiberWire had a significant increase in
friction when damaged (P ⫽ .03). PDS had no signif-
TABLE 2. Friction of Uncut and Cut Tevdek, PDS, and FiberWire in Metal and Bioabsorbable Anchors
Tevdek
Uncut suture
Metal anchor 0.32 ⫾ 0.01
Bioabsorbable anchor 0.29 ⫾ 0.01
Cut suture
Metal anchor 0.29 ⫾ 0.01
Bioabsorbable anchor 0.29 ⫾ 0.01
NOTE. A “greater than” sign indicates significantly greater, whereas an “equals” sign indicates that there is no significant difference
between the 2 sutures’ values.
659
icant change in friction when damaged (P ⫽ .17).
Tevdek had a significant decrease in friction when
damaged (P ⫽ .014). When being pulled through a
bioabsorbable anchor, no suture had a significant
change in friction when damaged (P ⫽ .52).
DISCUSSION
In this study we tested the strength (LTF and FS)
and friction of undamaged and damaged sutures in
metal and bioabsorbable anchors. For metal anchors,
failure occurred exclusively by suture breakage. Dam-
aged FiberWire was found to be stronger (higher LTF
and FS) in metal anchors than in bioabsorbable an-
chors because in bioabsorbable anchors, FiberWire’s
high LTF shifts the failure mechanism from suture
failure to eyelet failure. This is similar to the findings
of Bardana et al.,1 who reported that constructs using
bioabsorbable anchors had a mixture of suture and
anchor eyelet failures. The metal Corkscrew anchor
and its eyelet are cast from the same piece of metal,
leading to significant anchor eyelet strength. The bio-
absorbable anchor’s eyelet is made of No. 3 Tevdek
suture, which is molded into the anchor’s polymer. It
is therefore significantly weaker than the metal an-
chor’s eyelet.
Although all tests that resulted in anchor damage
were not used for the purposes of the results, the fact
that 2 of 8 bioabsorbable anchor eyelets were de-
stroyed by damaged FiberWire lowers the mean
strength of the construct by invalidating those trials
in which the strength of the damaged FiberWire
was above that of the bioabsorbable anchor’s eye-
lets. Given that the tensile strength of undamaged
FiberWire was higher than that of the bioabsorbable
anchor’s eyelet, the bioabsorbable anchors themselves
limited the strength of the FiberWire-anchor con-
struct, and it was not possible to test the mechanical
Fa/Fp
PDS FiberWire Significance
0.37 ⫾ 0.02 0.31 ⫾ 0.02 PDS ⬎ FW ⫽ Tevdek
0.33 ⫾ 0.01 0.29 ⫾ 0.01 PDS ⬎ FW ⫽ Tevdek
0.39 ⫾ 0.01 0.33 ⫾ 0.02 PDS ⬎ FW ⬎ Tevdek
0.34 ⫾ 0.01 0.29 ⫾ 0.02 PDS ⬎ FW ⫽ Tevdek
660 P. B. WRIGHT ET AL.
properties of uncut FiberWire in this setting. For
Tevdek and PDS, the sutures themselves were the
limiting factor of the suture– bioabsorbable anchor
construct.
Undamaged FiberWire had a significantly higher
LTF than PDS with both metal and bioabsorbable
anchors, and both FiberWire and PDS had a signifi-
cantly higher LTF than Tevdek. With metal anchors,
there was no significant difference between the FS for
FiberWire and PDS, implying that with its greater
cross-sectional area adjusted for, the undamaged com-
posite FiberWire material had no increased strength
compared with undamaged PDS. For metal anchors,
both undamaged FiberWire and PDS had a signifi-
cantly higher FS than undamaged Tevdek. For bioab-
sorbable anchors, there was no significant difference
in FS between undamaged PDS and Tevdek. This sug-
gests that when interacting with a metal eyelet, Tevdek
has inferior mechanical (structural and material) proper-
ties compared with both PDS and FiberWire sutures.
Undamaged PDS may have a significantly greater
FS than Tevdek through metal anchors, but not
through bioabsorbable anchors, because Tevdek may
be more sensitive to the sharper edges of the metal
eyelet. As noted in a previous study,2 PDS lost sig-
nificantly more strength (LTF and FS) when damaged
than did the other sutures. For both anchor types,
damaged PDS had a significantly lower strength (LTF
and FS) than did Tevdek and FiberWire. For metal
anchors, damaged FiberWire had a greater strength
(LTF and FS) than did Tevdek. For bioabsorbable
anchors, although damaged FiberWire had a higher
LTF than damaged Tevdek, there was no significant
difference between their FS. This implies that, with its
greater cross-sectional area accounted for, the dam-
aged composite FiberWire material did not have
greater strength than cut Tevdek. It is possible that
Tevdek may be relatively stronger in bioabsorbable
anchors because of the lack of sharp edges on their
eyelets.
All sutures lost significant LTF when damaged.
Neither FiberWire nor Tevdek had a significant loss of
FS when damaged, implying that for these sutures, FS
is, in fact, truly a material property. However, PDS did
have a significant loss of FS when damaged. This may
be because of the fact that PDS is a monofilament and
not a braided suture (made up of bundles of individual
fibers), such as FiberWire and Tevdek. When mono-
filament suture is damaged, there is an increase of
stress concentration at the leading edge of the cut,
which greatly decreases the force required to cause
failure. This may be why both the LTF and FS of PDS
decreased so greatly when damaged. Damaging a
braided suture does not increase the stress concentra-
tion as much because there is no leading edge, given
that there are still intact bundles on the edge of the cut.
PDS was one of the first sutures used for arthro-
scopic shoulder reconstructions.6-8 PDS is an absorb-
able monofilament suture composed of the polyester
poly(p-dioxanone). Surgeons then began using nonab-
sorbable sutures, such as Tevdek. Tevdek is a braided
polyester suture impregnated with polytetrafluoroeth-
ylene. Newer hybrid sutures have been developed and
are now popular for shoulder reconstructions.9,10
FiberWire has an ultrahigh–molecular weight polyeth-
ylene core with a braided polyethylene terephthalate
polyester ultrahigh–molecular weight polyethylene
jacket.
Under cyclic loading, sutures may abrade on their
anchor’s eyelet. The friction created depends on the
design of the anchor eyelet, the roughness of the
matching surfaces, and the arc of contact between
the suture material and the anchor eyelet. In the study
of Bardana et al.,1 sutures performed significantly
better when cycled at an angle of pull in line with the
anchors. To compare metal and bioabsorbable an-
chors, we chose to use these optimum conditions. We
noted that, for all undamaged and damaged sutures,
friction was less in bioabsorbable anchors compared
with metal anchors. In addition, when being pulled
through a bioabsorbable anchor, no suture had a sig-
nificant change in friction when damaged. This agrees
with the findings of previous authors who noted that
metallic anchors tend to have rough eyelet surfaces
with sharp edges, which may damage sutures, leading
to failure,1,5 whereas the eyelets of bioabsorbable im-
plants have smoother edges, decreasing suture abra-
sion under cyclic loading.11
PDS (undamaged or damaged, in either metal or
bioabsorbable anchors) had significantly more friction
than the other sutures tested, which may predispose it
to damage, which then weakens it significantly. In
metal anchors FiberWire’s friction increased signifi-
cantly when damaged and was significantly greater
than cut Tevdek. This may be due to the fact that
FiberWire is stiffer than Tevdek,2 allowing its cut
edge to catch the metal eyelet with greater force.
As is the case for all in vitro studies, ours has
several limitations. The amount of damage studied
here (33% of suture diameter) may over- or under-
represent the damage present in common clinical sit-
uations, and a razor blade may not exactly simulate
damage that occurs in vivo. However, it is difficult to
classify the damage that occurs to a suture in the
 SUTURES AND METAL AND BIOABSORBABLE ANCHORS
“typical” in vivo situation, because suture damage
may vary with the procedure performed, equipment
used, and surgeon’s skill level.
Sutures may act differently in an in vivo environ-
ment compared with an in vitro experiment. Specifi-
cally, friction between a suture and the anchor eyelet
may be different in a fluid environment. Furthermore,
the friction-testing model—where one suture end is
pulled straight in line with the suture anchor axis and
the second suture end is pulled at a 45° angle—may
not accurately reflect the resulting pull of the sutures
in the human shoulder.
We used static tensile failure rather than cyclic
loading to failure, which may better represent the
clinical situation. This study is an initial attempt to
examine the biomechanical properties of undamaged
and damaged sutures in metal and bioabsorbable an-
chors, and further study is needed to fully understand
suture interactions in the in vivo environment.
Because damaged FiberWire destroyed 2 bioab-
sorbable anchor eyelets, 2 of this suture’s strongest
runs had to be disqualified, potentially lowering the
mean strength of damaged FiberWire noted in this
study. Therefore the reported results probably under-
estimate the strength of damaged FiberWire. Alterna-
tively, because visually undamaged anchors were reused,
it is possible that the anchor eyelets that failed were
subtly weakened, in which case the strength of damaged
FiberWire would not have been underestimated.
Ideally, sutures should be strong enough to with-
stand the forces applied to them and should show little
creep during the healing process. Although newer
sutures generally have greater strength and stiffness
than older sutures, it is unknown whether this strength
is needed for clinical success or whether the increased
stiffness of these new sutures might lead to the sutures
cutting through the soft tissues or the cortical margin
of the bone over which they are tensioned.11,12 Other
important properties such as knot security, suture cut-
out through soft tissues, and biocompatibility were
also not examined in our study. Therefore our results
should be extrapolated with care.
Although other new hybrid sutures are now being
marketed, we tested only one of each suture class
(absorbable PDS, nonabsorbable Tevdek, and hybrid
FiberWire) to provide insight into the biomechanical
differences between these different suture classes. The
results of this study may be updated with other more
recently developed sutures at a future time.
661
CONCLUSIONS
The strength of the eyelet of the metal suture anchor
used in this study exceeded the suture strength for all
sutures tested in vitro. Bioabsorbable suture eyelet
strength was less than undamaged FiberWire suture
strength but stronger than Tevdek and PDS via this
testing model. The undamaged or damaged FiberWire-
anchor construct is significantly weaker when bioabsorb-
able anchors are used instead of metal anchors. For
Tevdek and PDS sutures, the anchor type does not
affect the strength of the construct, because the suture
is the limiting factor. When used with suture anchors,
PDS has the most friction of the sutures tested, poten-
tially leading to suture damage, which disproportion-
ately weakens PDS compared with the other sutures
tested. For both undamaged and damaged sutures,
bioabsorbable anchors lead to less friction than do
metal anchors under dry in vitro conditions.
REFERENCES
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suture anchor design and orientation on suture abrasion: An in
vitro study. Arthroscopy 2003;19:274-281.
2. Wright PB, Budoff JE, Yeh ML, Kelm ZS, Luo ZP. Strength of
damaged suture: An in vitro study. Arthroscopy 2006;22:1270-
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