What is the best suture material to use for a knee laceration?

Best Suture Material for Knee Laceration

For knee lacerations, monofilament sutures are strongly recommended as they cause less bacterial seeding and are associated with a significantly lower risk of infection compared to multifilament sutures. 1

Optimal Suture Material Characteristics

• Monofilament sutures are preferred for knee lacerations due to their lower resistance when passed through tissues and reduced risk of bacterial seeding 1, 2
• Slowly absorbable monofilament sutures (like poliglecaprone/MONOCRYL or polyglyconate/Maxon) are ideal choices as they provide adequate tensile strength during the healing period while eliminating the need for suture removal 1, 3
• Antimicrobial-coated sutures (typically triclosan-impregnated) should be used when available, as they significantly reduce the rate of surgical site infections in clean and clean-contaminated wounds 1
• The smallest suture size that will accomplish adequate wound closure should be chosen (typically 4-0 or 5-0) to minimize tissue trauma and foreign material within tissues 2

Suturing Technique Recommendations

• Continuous non-locking suturing technique is preferred over interrupted sutures as it:
  • Distributes tension more evenly across the entire length of the suture 1
  • Results in less short-term pain and improved healing 1
  • Reduces the amount of suture material used 1, 3
• "Small bite" technique (approximately 5mm from wound edges and 5mm between stitches) ensures adequate distribution of tension and minimizes tissue damage 1
• Avoid locking sutures as they can cause excessive tension leading to tissue edema and necrosis 1

Specific Suture Material Options (Ranked)

1. First choice: Monofilament absorbable antimicrobial-coated sutures (e.g., triclosan-impregnated poliglecaprone/MONOCRYL)

   • Combines the benefits of monofilament structure with infection prevention 1
   • Eliminates the need for suture removal in a high-mobility area 3
   • Maintains adequate tensile strength during critical healing period 4

2. Second choice: Standard monofilament absorbable sutures (e.g., poliglecaprone/MONOCRYL or polyglyconate/Maxon)

   • Provides excellent knot security and flexibility 3, 5
   • Demonstrated superior cosmetic results compared to non-absorbable options 3
   • Fewer complications compared to barbed sutures 3

3. Third choice: Monofilament non-absorbable sutures (e.g., nylon, polypropylene)

   • Good tensile strength but requires removal 6
   • Polypropylene has excellent knot-holding capacity 6

Important Considerations for Knee Lacerations

• The knee is a high-mobility area that experiences significant tension during healing, requiring suture material with adequate tensile strength 3
• Sutures should remain in place for 10-14 days due to the high mobility and tension in this region 7
• Continuous subcuticular closure with monofilament absorbable suture provides the best balance of strength, cosmetic outcome, and patient comfort 1, 3

Pitfalls to Avoid

• Avoid multifilament sutures as they have higher tissue friction and pose increased risks of suture sinus and infection 2
• Avoid excessive tension when closing knee lacerations as this can lead to tissue ischemia and poor healing 2
• Avoid catgut sutures as they are associated with more pain and higher risk of requiring resuturing 8
• Be cautious with barbed sutures (like Stratafix) as they may have higher complication rates despite their theoretical advantages 3