Introduction Sutures can be classifi ed into different groups depending on their origin (natural or synthetic), their structure (monofi lament or braided), their biostability (resorbable or nonresorbable) and whether or not they contain barbs (Fig. 13.1). Tendon repair techniques such as Bunnell, Tsuge, Tajima, Strickland, Kessler, modifi ed Kessler, Savage, Becker, modifi ed Becker (MGH repair), and Indianapolis repair require use of tying knots. These knots are undesirable. Knot security, for example, is still an important issue for knotted sutures (Gupta, 2004; Chu, 2004). Disadvantages of knotted sutures include: • delay of wound healing, • constriction of blood fl ow, • distortion of tissue which can lead to necrosis and scar formation, and • loss of knot security due to increased local stress concentrations. Barbed sutures eliminate this type of risk associated with knot failure. A barbed suture is a special kind of suture which can anastomose tissue without the need to tie a knot (Leung et al ., 2002, 2003a, 2003b, 2003c, 2004a, 2004b, 2004d; Ingle, 2003; Leung, 2004). This is possible due to the profi le and orientation of the barbs, which are incorporated along the outer surface of a monofi lament suture. Some common trade names for barbed