A Biomechanical Comparison of Modified Krackow and Locking Loop Suture Patterns for Soft-Tissue Graft Fixation

Ostrander, Roger V.; Saper, Michael G.; Juelson, Timothy J.

doi:10.1016/j.arthro.2016.01.054

Cited by 18 publications

(19 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Firstly, the use of porcine Achilles tendon specimens may not perfectly represent the dimensions and architecture observed in human tendons. However, porcine tendon has been used in a number of studies evaluating different fixation techniques for tendon restoration (19,20). Secondly, percutaneous restorations in the present study were made using an open approach simulating the restoration technique without specialized stitching devices, which may have led to inaccurate repairing.…”

Section: Discussionmentioning

confidence: 99%

“…Following the completion of suture-graft constructs, each specimen was mounted below the dynamometer with the non-sutured end of the tendon wrapped with gauze to eliminate slippage while secured in a custom clamp. The free strands of the suture were tied with '8' square knots over a custom bar of the universal material testing machine, mimicking a suture post in vivo (19)(20)(21). The non-sutured end of the tendon was in close proximity to the bar to minimize elongation of the suture.…”

Section: Animalsmentioning

confidence: 99%

See 1 more Smart Citation

Comparison of channel‑assisted minimally invasive repair and 3 common Achilles tendon restoration techniques

Cui

et al. 2018

Exp Ther Med

View full text Add to dashboard Cite

The present study aimed to investigate the biomechanical comparison of channel-assisted minimally invasive restoration and three common Achilles tendon restoration techniques in an in vitro model via a progressive rehabilitation program. The 42 porcine tendons were randomly assigned to the following six groups of tendons (n=7/group): Achillon, percutaneous Achilles repair system (PARS), Krackow, channel-assisted minimally invasive repair (CAMIR), CAMIR augmentation (CAMIR +), CAMIR-5 (repair with No. 5 Ethibond suture). There was no significant difference in elongation among groups following the first 10 loading cycles, which consisted of 20-100 N at 1 Hz. The elongation of the CAMIR group (7.51±1.77 mm) was significantly longer than the Achillon group (3.19±0.57 mm) and PARS group (3.73±0.66 mm; P<0.05) following 1,000 cycles. However, the CAMIR group exhibited no significant difference vs. the Krackow (7.32±1.09 mm) and CAMIR + groups (7.11±1.50 mm) following 1,000 cycles. Following 2,000 cycles, there was no significant difference between the CAMIR-5 (7.99±1.68 mm) group, and the Achillon (3.19±0.57 mm) and PARS groups (3.73±0.66 mm). At the point of restoration construct failure, the total cycles of the CAMIR group (median, 1,000; range, 1,000-1,000) were significantly less than the Achillon group (median, 2,000; range, 2,000-2,013) and PARS group (median, 2,000; range, 2,000-2,010; P<0.05), but had no significant difference compared with the Krackow group (median, 1,000; range, 1,000-1,000) and CAMIR + group 1,000 (median, 1,000; range, 1,000-1,004). There was also no significant difference between the CAMIR-5 group (median, 2,000; range, 2,000-2,000), and the Achillon group (median, 2,000; range, 2,000-2,013) and PARS group (median, 2,000; range, 2,000-2,010). Restricted by the strength of suture, the one-suture CAMIR restoration technique was weaker than the three-suture Achillon and PARS restoration techniques, but there was no significant difference with the open Krackow restoration technique, which provides a reliable mechanical strength for repairing. CAMIR has an advantage of reducing the risk of suture reactivity.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Animalsmentioning

confidence: 99%

Comparison of channel‑assisted minimally invasive repair and 3 common Achilles tendon restoration techniques

Cui

et al. 2018

Exp Ther Med

View full text Add to dashboard Cite

show abstract

“…Other sutures for the same purpose are the Krakow suture, the Speed Whip or the Chinese finger-trap suture. Studies have shown that there is no significant difference between modified Krakow and modified Speed Whip concerning cyclic load and maximum load [ 9 ]. We found no studies comparing the double whip stitch with any of the other type of tendon suture mentioned.…”

Section: Discussionmentioning

confidence: 99%

“…Shearing of tendon at the suture end occurred in 2 cases, which can be explained by different biomechanical properties and resistance among samples and also by the distance between the end of the tendon and first loop execution (5 mm). Other studies used similar suture type with first loop executed at 10mm from tendon end [ 9 ]. It is possible to obtain better loop security at free tendon end by observing the 10 mm distance when the construct is submitted at high loads.…”

Section: Discussionmentioning

confidence: 99%

Double whip stitch for free graft femoral fixation in ACL reconstruction: experimental study on porcine model

Buescu

Dudescu

Caterev³

et al. 2018

Medicine and Pharmacy Reports

View full text Add to dashboard Cite

Background and aimsUsing free quadriceps tendon graft for anterior cruciate ligament (ACL) reconstruction has become more popular in the last years due to the low morbidity at the harvest site and biomechanical and structural properties similar to other types of graft (hamstring and patellar tendons). As long as the tibial tunnel fixation with interference screws is considered the standard fixation, femoral fixation is still an open subject. Even though the most common type of femoral tunnel fixation are the cortical suspension devices, the type of suture used for tying the graft to the loop is still evaluated and discussed. We aimed to evaluate the resistance and elongation of a double whip stitch used for tying a tendon to the loop of a cortical suspension device.MethodWe used 10 porcine flexor digitorum profundus as free graft for a graft-suture-cortical suspension device construct using the double whip stitch. The total length of the construct and tendon length were recorded before and after the test was performed. Tensioning curves, total construct elongation and maximum tension at breaking point were electronically recorded on the testing device’s software. The mean values and coefficient of variance were assessed.ResultsWe noted the breaking of the suture wire where the wires passed through the loop of the cortical suspension device as final point for all tests. The mean of maximum load was 505.68N (Max=639.38 N; min=358.93 N; SD=82.88078 N) and the mean of total construct elongation was 39.54784mm (Max= 48.60466 mm; min=31.74853 mm; SD=4.85371 mm).ConclusionWith some minor improvement in technique and graft preconditioning and pretensioning, the double whip stitch can be used in connecting a free tendon to a cortical suspension device.

show abstract

“…7 Gnandt et al show during a single load to failure that highetensile strength tape performs more favorably than highetensile strength suture, with a greater mean load to failure, in both the whip-and Krackow-stitch models. 8 In the 3-plus decades since its introduction, Krackow stitch variants continue to provide surgeons with secure fixation at the tendon-suture interface. Innovation in suture size, type, and strength keeps the Krackow…”

Section: See Related Article On Page 663mentioning

confidence: 99%

Editorial Commentary: The Krackow Stitch: More Than 30 Years of Tendon Repair and Still Holding Strong

Sherman¹

2018

Arthroscopy: The Journal of Arthroscopic & Related Surgery

View full text Add to dashboard Cite

Security at the suture-tendon interface is a critical component of soft tissue fixation. For more than 3 decades, the Krackow stitch has been considered the gold standard for soft tissue fixation. Modifications of the original configuration have withstood the test of time. Many have been evaluated in preclinical and clinical studies for multiple musculoskeletal applications. Most recently, double Krackow suture configurations have been shown to increase the ultimate failure load of the suture-tendon construct. I have learned this stitch and will add it to my soft tissue fixation arsenal.

show abstract

A Biomechanical Comparison of Modified Krackow and Locking Loop Suture Patterns for Soft-Tissue Graft Fixation

Cited by 18 publications

References 16 publications

Comparison of channel‑assisted minimally invasive repair and 3 common Achilles tendon restoration techniques

Comparison of channel‑assisted minimally invasive repair and 3 common Achilles tendon restoration techniques

Double whip stitch for free graft femoral fixation in ACL reconstruction: experimental study on porcine model

Editorial Commentary: The Krackow Stitch: More Than 30 Years of Tendon Repair and Still Holding Strong

Contact Info

Product

Resources

About