The effect of pulsed lavage irrigation on suture knot security

Purpose: The purpose of this study was to determine the effect of low-pressure and pulsed lavage irrigation on suture knot security. Methods: Ninety-tied suture loops were measured for baseline circumference and then subjected to no irrigation, bulb syringe irrigation, or pulsed lavage irrigation. The sutures were placed under a load and then measured for final circumference. A larger circumference difference indicated poorer knot security. Results: There was a statistically significant difference in the knot security between all three groups (p < 0.001). Pulsed lavage resulted in the greatest circumference increase (0.52 +/- 0.19 mm), followed by bulb syringe (0.24 +/- 0.18 mm), and lastly no irrigation (0.08 +/- 0.00 mm). None of the groups had any catastrophic failures. No knots met the predetermined criteria for knot failure. Conclusion: Pulsed lavage irrigation resulted in a statistically significant decrease in suture knot security as compared to bulb syringe irrigation and no irrigation. None of the groups met the currently accepted criteria for clinical suture failure, which has a relatively arbitrary value. While the available literature does not discuss increases in loop circumference for specific orthopedic applications, this small difference suggests that pulse lavage is unlikely to have a clinically significant impact on the suture integrity for most orthopedic procedures.