Comparison of Suture Techniques Using a Looped Suture

Location

LSU Health NO Center for Advanced Learning and Simulation (CALS)

Document Type

Event

Start Date

20-6-2026 8:15 AM

End Date

20-6-2026 8:45 AM

Publication Date

June 2026

Description

Introduction: The tendon-suture interface is one of the weakest points in the anchoring and tensioning of cadaver and autologous grafts alike1. Several techniques have been reviewed to similarly alleviate this problem, however, heterogeneity in methodology, stitch type and graft type make these reviews difficult to compare for strength and length of procedure. The Arthrex SpeedWhip with FiberLoop is utilized significantly for its ability to increase the speed of both the cadaveric and autologous tendons for preparation across several ligament sources (ACL, PCL, LCL and MCL reconstructions). However, this technique has the potential to cause graft laceration, graft elongation, and place undue stress on the tendon. In response to this complication, Arthrex created a different product, the FiberLoop with FiberTag. After reviewing the literature, we have developed a new technique which overcomes this problem without the need for a different product and could be performed with a standard Keith needle and suture. Using the same methodology and technique, we hoped to accomplish a fair comparison between the techniques that can be used for adequate assessment of the suturing choice. This paper focuses on the comparison between the strength, elongation and time of procedure between the original Arthrex SpeedWhip and the modified SpeedWhip.

Methods: Anatomical specimen/tendon grafts - 5 cadaveric semitendinosus were collected and utilized in the biomechanical trials from the Musculoskeletal Transplant Foundation. The grafts were cut in half such that they could be used as their own control (one side using the original speedwhip, the other side using the modified speedwhip). All specimens were properly disposed of after conclusion of the trial by the Orthopaedic Surgery department at Tulane School of Medicine. Suture materials - Throughout the trial, the straight-needle FiberLoop, developed by Arthrex, was used. This continuous loop of #2 FiberWire thread on a thin needle allows for increased strength in the procedure when compared to standard stitching alone, as well as increased mobility when maneuvering through tissue to facilitate even tensioning. Suturing technique - The suturing techniques evaluated in this trial included the Arthrex SpeedWhip technique with Fiberloop and a modified SpeedWhip technique using the same Arthrex fiberloop. The modified speedwhip technique incorporates a simple twist between passes to turn the suture into a locking stitch as opposed to a running stitch. General Suture Description - The proximal end of the tendon was fixed in a clamp. The tendon was cut 4 cm from the end of the clamp. The free end was held in an Allis clamp. Starting at 1 cm distal to the clamp, the suture was passed at 5 mm intervals for a total of 5 passes using one of the two techniques. For each graft, we alternated which technique was used on each half of the tendon. Each technique was tested with 2 proximal halves and 2 distal halves. Biomechanical traction protocol/data collection - The construct was placed in a MTS machine, with the clamped tendon fixed to one side and the suture to the other. The MTS machine then placed tension on the construct and a stress strain curve was recorded. Once the measurement of the clamped tendon was completed, the other half of the tendon was then placed in the jig and tested in similar fashion. Sample data was acquired every 0.06 seconds with the initial recording set to 0 Newtons after the complex was tightened at 5mm/s until 10 Newtons was reached. This tension was then decreased to zero. The tension was measured at the set interval from this point forward. The speed of the MTS machine was preconditioned to 10 cycles from 10 to 100 Newtons with a speed of 20mm/min. Without relaxing the complex, the load was increased by 20mm/min until failure, which was defined as rupture of the tendon due to strangulation by the thread or breakage of the suture. The distance was also measured after the 10th cycle to 100 Newtons while also utilizing our Fmax equation for the position at 100 Newtons. Finally, we measured the position of 0 Newtons compared to the position of 100 Newtons after the 10th cycle.

Results: After the 1st cycle of tension testing and 10th cycle in testing, the modified SpeedWhip technique had a 78.8% and 75.4% lower elongation than the original speedwhip technique, respectively. When looking at the change in length between the first and tenth cycle, the modified SpeedWhip technique had a 66% decrease in elongation compared with the original speedwhip technique. The modified speedwhip technique had a 41.1% greater strength to failure than the original speedwhich technique. All tested variables were significant for P<0.05.

Discussion: This study was conducted to evaluate the biomechanical efficiency of the a new modified SpeedWhip technique. The outcome goals for procedures of tendon and ligament repair/reconstruction involve strength to failure and prevention of tissue laceration, both of which are crucial to success post-operatively. The Arthrex SpeedWhip has been used in clinical practice abundantly. This new technique simply incorporates simple twist that does not cost any more money and does not take significantly longer to prepare. This new knot is easily reproducible and can be incorporated into a plethora of orthopaedic tendon repairs and reconstructions. As with all new techniques, we recommend that this technique be tested in a dry-lab setting prior to the operative suite. Limitations of the study include low graft testing numbers. Future studies may compare this technique vs fibertag implants.

Significance/Clinical Relevance: The modified SpeedWhip provided more higher strength to failure and a lower degree of elongation/ graft laceration when compared to the original Arthrex SpeedWhip stitch.

This document is currently not available here.

Share

COinS
 
Jun 20th, 8:15 AM Jun 20th, 8:45 AM

Comparison of Suture Techniques Using a Looped Suture

LSU Health NO Center for Advanced Learning and Simulation (CALS)

Introduction: The tendon-suture interface is one of the weakest points in the anchoring and tensioning of cadaver and autologous grafts alike1. Several techniques have been reviewed to similarly alleviate this problem, however, heterogeneity in methodology, stitch type and graft type make these reviews difficult to compare for strength and length of procedure. The Arthrex SpeedWhip with FiberLoop is utilized significantly for its ability to increase the speed of both the cadaveric and autologous tendons for preparation across several ligament sources (ACL, PCL, LCL and MCL reconstructions). However, this technique has the potential to cause graft laceration, graft elongation, and place undue stress on the tendon. In response to this complication, Arthrex created a different product, the FiberLoop with FiberTag. After reviewing the literature, we have developed a new technique which overcomes this problem without the need for a different product and could be performed with a standard Keith needle and suture. Using the same methodology and technique, we hoped to accomplish a fair comparison between the techniques that can be used for adequate assessment of the suturing choice. This paper focuses on the comparison between the strength, elongation and time of procedure between the original Arthrex SpeedWhip and the modified SpeedWhip.

Methods: Anatomical specimen/tendon grafts - 5 cadaveric semitendinosus were collected and utilized in the biomechanical trials from the Musculoskeletal Transplant Foundation. The grafts were cut in half such that they could be used as their own control (one side using the original speedwhip, the other side using the modified speedwhip). All specimens were properly disposed of after conclusion of the trial by the Orthopaedic Surgery department at Tulane School of Medicine. Suture materials - Throughout the trial, the straight-needle FiberLoop, developed by Arthrex, was used. This continuous loop of #2 FiberWire thread on a thin needle allows for increased strength in the procedure when compared to standard stitching alone, as well as increased mobility when maneuvering through tissue to facilitate even tensioning. Suturing technique - The suturing techniques evaluated in this trial included the Arthrex SpeedWhip technique with Fiberloop and a modified SpeedWhip technique using the same Arthrex fiberloop. The modified speedwhip technique incorporates a simple twist between passes to turn the suture into a locking stitch as opposed to a running stitch. General Suture Description - The proximal end of the tendon was fixed in a clamp. The tendon was cut 4 cm from the end of the clamp. The free end was held in an Allis clamp. Starting at 1 cm distal to the clamp, the suture was passed at 5 mm intervals for a total of 5 passes using one of the two techniques. For each graft, we alternated which technique was used on each half of the tendon. Each technique was tested with 2 proximal halves and 2 distal halves. Biomechanical traction protocol/data collection - The construct was placed in a MTS machine, with the clamped tendon fixed to one side and the suture to the other. The MTS machine then placed tension on the construct and a stress strain curve was recorded. Once the measurement of the clamped tendon was completed, the other half of the tendon was then placed in the jig and tested in similar fashion. Sample data was acquired every 0.06 seconds with the initial recording set to 0 Newtons after the complex was tightened at 5mm/s until 10 Newtons was reached. This tension was then decreased to zero. The tension was measured at the set interval from this point forward. The speed of the MTS machine was preconditioned to 10 cycles from 10 to 100 Newtons with a speed of 20mm/min. Without relaxing the complex, the load was increased by 20mm/min until failure, which was defined as rupture of the tendon due to strangulation by the thread or breakage of the suture. The distance was also measured after the 10th cycle to 100 Newtons while also utilizing our Fmax equation for the position at 100 Newtons. Finally, we measured the position of 0 Newtons compared to the position of 100 Newtons after the 10th cycle.

Results: After the 1st cycle of tension testing and 10th cycle in testing, the modified SpeedWhip technique had a 78.8% and 75.4% lower elongation than the original speedwhip technique, respectively. When looking at the change in length between the first and tenth cycle, the modified SpeedWhip technique had a 66% decrease in elongation compared with the original speedwhip technique. The modified speedwhip technique had a 41.1% greater strength to failure than the original speedwhich technique. All tested variables were significant for P<0.05.

Discussion: This study was conducted to evaluate the biomechanical efficiency of the a new modified SpeedWhip technique. The outcome goals for procedures of tendon and ligament repair/reconstruction involve strength to failure and prevention of tissue laceration, both of which are crucial to success post-operatively. The Arthrex SpeedWhip has been used in clinical practice abundantly. This new technique simply incorporates simple twist that does not cost any more money and does not take significantly longer to prepare. This new knot is easily reproducible and can be incorporated into a plethora of orthopaedic tendon repairs and reconstructions. As with all new techniques, we recommend that this technique be tested in a dry-lab setting prior to the operative suite. Limitations of the study include low graft testing numbers. Future studies may compare this technique vs fibertag implants.

Significance/Clinical Relevance: The modified SpeedWhip provided more higher strength to failure and a lower degree of elongation/ graft laceration when compared to the original Arthrex SpeedWhip stitch.