To compare the mechanical performance of 12 commonly used toggle suture constructs (TSCs).

Study Design

In vitro biomechanical study.

Sample Population

Toggle suture constructs (n = 136).


TSC evaluated included #5 OrthoFiber, double strand of 5 Ethibond sutures (polyethylene terephthalate suture), 80 lb monofilament nylon, or #5 FiberWire, combined with Piermattei toggle (3/32" Steinmann pin), modified Piermattei toggle (0.045" Kirschner wire), and 1/8" Securos toggle rod for a total of 12 test groups. Acute and cyclic testing were performed using a servohydraulic testing machine and load at failure and cycles to failure were determined.


In acute testing, modified Piermattei TSCs failed by toggle deformation and Piermattei and Securos TSCs failed by suture breakage at the eyelet. Mean failure load of Piermattei-#5 OrthoFiber TSC (1416 ± 74 N) was significantly greater than that of Piermattei-#5 Ethibond (883 ± 38 N); both were significantly greater than all other TSCs. Only the Piermattei TSC with #5 OrthoFiber, #5 Ethibond, and 80 lb monofilament nylon did not fail during cyclic testing.


A combination of the Piermattei toggle and #5 OrthoFiber or #5 Ethibond achieved a higher load at failure than all other groups, and resisted the greatest number of cycles to failure. Long-term mechanical testing of these TSCs are warranted to further define their durability.