Bacterial Adherence to High–Tensile Strength Sutures

PurposeThe purpose of this study was to evaluate the bacterial adherence to high–tensile strength suture materials using a bioluminescent in vitro model.MethodsEleven strands each of No. 2 MaxBraid (Arthrotek [Biomet], Warsaw, IN), FiberWire (Arthrex, Naples, FL), Ethibond (Ethicon, Somerville, NJ), Orthocord (DePuy Mitek, Raynham, MA), and silk (Ethicon) sutures were immersed in a broth of bioluminescent Staphylococcus aureus, which is genetically engineered to emit photons. After 12 hours in the broth, the suture strands were individually irrigated with 10 mL of low-pressure normal saline solution and imaged with a photon-capturing camera system that yields a total photon count that correlates directly with residual bacterial counts.ResultsMaxBraid had the greatest adherence, followed by FiberWire, Ethibond, Orthocord, and silk. Orthocord had only 25% of the bacterial adherence of MaxBraid (P < .001). Ethibond and FiberWire had 53% (P < .001) and 75% (P = .003) of the adherence of MaxBraid, respectively. Differences between each suture were also statistically significant, with Ethibond and Orthocord having 71% (P = .007) and 33% (P < .001) of the adherence of FiberWire, respectively, and Orthocord having 47% (P < .001) of the adherence of Ethibond. The adherence to silk was statistically lower than all of the high–tensile strength sutures.ConclusionsAmong high–tensile strength sutures, Orthocord has significantly less bacterial adherence than MaxBraid and FiberWire. Although infections in arthroscopic shoulder surgery are rare, the physical properties of surgical implants should be known by surgeons. In addition, bacterial adherence may contribute to suture selection in a patient prone to infection or to the use of suture in other body areas at greater risk for contamination.Clinical RelevanceBacterial adherence to high–tensile strength sutures may be a useful factor in implant selection in a patient with predisposition for contamination or infection.