Biomechanical Head-to-Head Comparison of 2 Sutures and the Giftbox Versus Bunnell Techniques for Midsubstance Achilles Tendon Ruptures

Dyke, Rufus O Van; Chaudhary, Sejul A; Gould, Gregory C.; Trimba, Roman; Laughlin, Richard T.

doi:10.1177/2325967117707477

Cited by 19 publications

(25 citation statements)

References 26 publications

(59 reference statements)

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“…Therefore, this study could not determine whether early functional rehabilitation could be performed. Van Dyke [10] conducted a biomechanical test for the Giftbox suture, and no clinical failure was observed from 20 to 100 N over 10 0 0 cycles. The clinical load to failure was 373 ± 110 N, and the catastrophic failure was 379 ± 103 N for the Giftbox technique.…”

Section: Discussionmentioning

confidence: 99%

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Achilles tendon rupture repair: Biomechanical comparison of the locking block modified Krackow technique and the Giftbox technique

Tian

Rui

et al. 2020

Injury

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Background: Open Giftbox repair of the Achilles tendon has good biomechanical advantages, but it is not minimally invasive. We designed a peritendon fixation technique, the "Locking Block Modified Krackow" (LBMK) technique, to meet minimally invasive needs. This study used a simulated protocol of early rehabilitation to compare the biomechanics of LBMK with those of the Giftbox technique. Methods: Twenty fresh bovine Achilles tendon specimens were randomly assigned to either the LBMK group or the Giftbox group. The LBMK technique and the Giftbox technique were used as the main suture configurations, and transverse sutures were used as secondary suture configurations in both groups. Each repaired specimen was subjected to two cyclic loading protocols (20-100 N, 20-190 N). The gapping between the tendon ends was measured after each stage of loading. Finally, all specimens underwent a load-to-failure test at a stretching rate of 25 mm/s. Results: After the first loading stage, the mean tendon gapping was 0.76 ±0.44 mm in the LBMK group and 0.86 ± 0.47 mm in the Giftbox group ( p = 0.620). After the second loading test, the average gapping measures of the LBMK and Giftbox groups were 3.8 ± 1.9 mm and 4.2 ± 2.2 mm, respectively ( p = 0.466). Finally, the catastrophic load to failure was 732.8 ± 138 N in the LBMK group and 645.5 ± 121 N in the Giftbox group. The difference was statistically significant ( p = 0.023). Conclusion:Both the LBMK and Giftbox techniques meet the requirements of early rehabilitation, but the suture strength in the LBMK group was significantly higher than that in the Giftbox group.

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Section: Discussionmentioning

confidence: 99%

“…The site from which the stitch exits after passing through the loops was located at the corner of the last locking loop. concentrated stress at the crossing site may easily lead to failure of the knot or destroy the transverse limb [10] .…”

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confidence: 99%

Achilles tendon rupture repair: Biomechanical comparison of the locking block modified Krackow technique and the Giftbox technique

Tian

Rui

et al. 2020

Injury

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“…Previous biomechanical studies have shown that the giftbox core suture technique has less tendon gapping and greater elongation to failure strength. 27,55 Lee and colleagues reported improved Achilles tendon strength with the addition of an epitendinous cross-stitch weave augmentation. 29…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes and Complications Following Limited Open Achilles Repair Without an Instrumented Guide

et al. 2020

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Background: We report the clinical outcomes and complications following our limited open incision Achilles tendon repair technique without instrument guides. Methods: A total of 33 patients were included in this study. We recorded pre- and postoperative scores on the Foot and Ankle Disability Index (FADI), visual analog scale (VAS), and the Foot and Ankle Outcome Score (FAOS). Subgroup analyses were performed for acute (<2 weeks) and subacute (2-6 weeks) Achilles tendon repairs. A P value <.05 was considered significant for all statistical analyses. Results: The median time from injury to surgery was 10.0 days (range, 1-45 days). At a median follow-up of 3.7 years (range, 1.0-9.8 years), the average pre- and postoperative outcome scores improved significantly for the following: FADI index (49.1-98.4, P < .001), VAS (4.8-0.2, P < .001), FAOS Pain (54.8-99.2, P < .001), FAOS Symptoms (84.6-97.0, P < .001), FAOS activities of daily living (61.4-97.2, P < .001), FAOS Sports and Recreational Activity (39.5-98.5, P < .001), and FAOS quality of life (39.7-88.7, P < .001). There were no significant differences between pre- and postoperative outcome scores between the acute and subacute Achilles repair groups. There were no wound complication, reruptures, or reoperations in the entire cohort. Conclusion: Patients showed improvements in postoperative patient-reported outcome scores with minimal complications. There was no significant difference in outcomes for acute vs subacute repairs. Our limited open incision Achilles tendon repair, which required no additional targeting instrumentation, had favorable midterm results. Level of Evidence: Level IV, retrospective case series.

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“…5 Using simulated early rehabilitation biomechanical testing, Van Dyke et al showed that Giftbox-modified Krackow Achilles repair technique with FiberWire suture was stronger and more resistant to gap formation at the repair site than combinations that incorporated the Bunnell stitch or Ultrabraid suture. 2 Hong et al found no difference in cyclic load and load to failure between needleless knot techniques and Krackow configurations. 6 Ostrander et al found no difference to elongation in cyclic load between modified Krackow and modified locking Speedwhip stitch.…”

Section: See Related Article On Page 663mentioning

confidence: 98%

“…Today, Krackow stitches continue to be widely employed for a variety of large and small tendon repairs and reconstructions including Achilles, quadriceps, and patella tendon repair among others. [1][2][3] Surgeons continue to seek ways to improve the biomechanical strength of the construct while maintaining tendon vascularity and tissue morphology. .…”

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

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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.

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Biomechanical Head-to-Head Comparison of 2 Sutures and the Giftbox Versus Bunnell Techniques for Midsubstance Achilles Tendon Ruptures

Cited by 19 publications

References 26 publications

Achilles tendon rupture repair: Biomechanical comparison of the locking block modified Krackow technique and the Giftbox technique

Achilles tendon rupture repair: Biomechanical comparison of the locking block modified Krackow technique and the Giftbox technique

Clinical Outcomes and Complications Following Limited Open Achilles Repair Without an Instrumented Guide

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

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