Whip stitch versus grasping suture for tendon autograft.

Abstract

During tendon autograft harvest, either a grasping suture or traditional whip stitch can be used to grasp tendon prior to definitive bone fixation. Their grip strength has not, to our knowledge, been compared. This article compares a needle-free suture technique to a standard whip stitch by testing grip strength in vitro. Twelve uniform ovine flexor tendons were prepared; six tendons with a standard, non-locking whip stitch and six tendons with a grasping suture. All the samples were tested to failure in uniaxial tension in a materials testing machine. Load/displacement curves were generated, and qualitatively assessed and peak loads were compared. There were no significant differences between the groups in tendon length or diameter. Modes of failure between the groups, as characterised by the load/displacement curves, were quite distinct. Peak load to failure was lower in the utility suture group (mean peak load at failure 121.28 N) than the whip stitch group (mean peak load to failure 188.82 N). All failures in the utility suture group occurred when the suture snapped. The grasping suture described here is weaker than a standard whip stitch but may be sufficiently strong to harvest and handle tendon autograft. A standard whip stitch remains the choice for definitive graft fixation.