What sutures are appropriate for repairing a knee injury in patients with varying medical histories?

Appropriate Sutures for Knee Injury Repair

For knee injury repair requiring surgical closure, use monofilament absorbable sutures such as poliglecaprone (MONOCRYL) or polyglyconate (Maxon) in size 2-0 to 4-0, as these minimize bacterial seeding and infection risk while providing adequate tensile strength for this high-mobility joint. 1, 2

Optimal Suture Material Selection

Primary Recommendation: Monofilament Absorbable Sutures

• Monofilament absorbable sutures are strongly preferred because they cause less bacterial seeding and significantly reduce infection risk compared to multifilament options 1, 2, 3
• Specific materials include:
  • Poliglecaprone (MONOCRYL) - excellent handling and predictable absorption 1, 2
  • Polyglyconate (Maxon) - higher tensile strength for areas under tension 1
  • Polydioxanone (PDS) - extended strength retention for deep tissue layers 1

Alternative Options (When Monofilament Unavailable)

• Polyglactin 910 (VICRYL) - multifilament synthetic with good handling but higher infection risk than monofilament 1
• Polyglycolic acid (Dexon) - similar properties to VICRYL with acceptable tissue reaction 1, 4

Materials to AVOID

• Catgut sutures should NOT be used - associated with significantly more pain and highest risk of requiring resuturing 1, 2
• Silk and other braided nonabsorbable sutures - promote bacterial harboring and tissue erosion 2, 3

Suture Size Selection by Tissue Layer

Deep Fascial/Capsular Layer

• Use 2-0 absorbable monofilament for adequate tensile strength in high-tension areas 1
• The knee joint capsule and surrounding fascia require robust closure due to constant motion and weight-bearing forces 3

Subcutaneous Layer

• Use 3-0 or 4-0 absorbable monofilament to reduce dead space and support dermal layer 1, 2

Skin Closure

• Use 4-0 or 5-0 monofilament (absorbable or nonabsorbable depending on location and tension) 2, 3
• For areas requiring optimal cosmesis, 5-0 or 6-0 may be appropriate 2

Enhanced Infection Prevention Option

Antimicrobial-Coated Sutures

• Consider triclosan-coated VICRYL Plus (polyglactin 910) to reduce surgical site infection rates 1
• Meta-analysis demonstrates significant SSI reduction: OR 0.62 (95% CI 0.44-0.88) for triclosan-coated vs. uncoated sutures 1
• Particularly beneficial in clean-contaminated wounds or patients with infection risk factors 1
• The antimicrobial coating provides consistent infection reduction across different wound types and surgical procedures 1

Suturing Technique Considerations

Layered Closure Approach

• Close each anatomical layer separately starting with deepest structures (joint capsule if violated, then fascia, subcutaneous tissue, and finally skin) 1
• Use continuous suturing technique rather than interrupted sutures when possible - reduces pain, decreases suture removal needs, and distributes tension more evenly 1, 2

Critical Technical Pitfalls to Avoid

• Never place sutures too tightly - tissue strangulation impairs healing and increases dehiscence risk 2, 5
• Avoid multifilament sutures in contaminated wounds - significantly higher infection rates due to bacterial wicking 2, 3
• Do not use the smallest suture size available - balance between minimizing tissue trauma and providing adequate strength for the high-mobility knee joint 3

Special Patient Populations

Diabetic Patients

• Maintain preference for monofilament absorbable sutures as infection risk is already elevated 2
• Consider antimicrobial-coated options given delayed healing and increased infection susceptibility 1, 2
• Plan closer follow-up intervals (within 24-48 hours initially) 2

Patients with Bleeding Disorders

• Ensure meticulous hemostasis before closure 2
• Continuous suturing technique may reduce bleeding risk by providing more uniform tissue compression 2
• Consider slightly larger suture size (e.g., 2-0 instead of 3-0) for better hemostatic control 3

Contaminated or Infected Wounds

• Monofilament sutures are mandatory - multifilament materials dramatically increase infection rates in contaminated fields 2, 3
• Strongly consider triclosan-coated sutures - demonstrated efficacy even with prophylactic antibiotics (RR 0.79,95% CI 0.63-0.99) 1

Post-Repair Monitoring

Immediate Post-Operative Period

• Keep wound clean and dry for 24-48 hours 2
• Monitor for infection signs: increasing pain, erythema, swelling, purulent discharge, or fever 2, 5

Follow-Up Schedule

• Initial follow-up within 24-48 hours for high-risk patients (diabetes, contaminated wounds, significant tension) 2
• Standard follow-up at 7-10 days for suture removal if nonabsorbable skin sutures used 1
• Absorbable sutures eliminate need for removal, improving patient compliance and reducing healthcare visits 1, 4