Biomechanical Study of a Multifilament Stainless Steel Cable Crimp System Versus a Multistrand Ultra-High Molecular Weight Polyethylene Polyester Suture Krackow Technique for Achilles Tendon Rupture Repair

Nguyen, Teresa P.; Keyt, Lucas K.; Herfat, Safa; Gordon, Lewis R.; Palanca, Ariel

doi:10.1053/j.jfas.2019.01.022

Cited by 5 publications

(14 citation statements)

References 18 publications

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“…The search strategy yielded 2949 entries. Sixteen studies met the inclusion criteria for quantitative synthesis [5, 6, 10, 12, 14, 18, 20, 23, 24, 28, 30, 46, 50, 54, 75, 77]. The study search and selection flowchart, with reasons for exclusion, is shown in Fig.…”

Section: Resultsmentioning

confidence: 99%

“…Failure load was defined as load that induced gapping equal to or higher than 5 mm in three studies [10, 75, 77]. Nine studies included elongation with cyclic loading as an outcome [5, 6, 10, 12, 18, 24, 46, 54, 75]. Three studies measured total construct elongation [5, 10, 24], four studies measured gapping between tendon ends [6, 18, 54, 75], and two studies used other references [12, 46].…”

Section: Resultsmentioning

confidence: 99%

“…The increased tensile strength of these repairs may be related to load sharing between biomaterial and core repair construct, as hypothesized by Berlet et al [6]. Next in the ranking were the MFSS [54], PARS Midsubstance [12] and triple bundle stitch [30]. These techniques ranked higher than the Krackow stitch, which is still considered the gold standard for soft tissue fixation [68].…”

Section: Discussionmentioning

confidence: 99%

“…Their superiority may be related to the number of suture strands crossing the rupture site [73], avoiding the use of knots, or tying of sutures away from the rupture site [30]. Interestingly, the double Krackow ranked lower than the single Krackow stitch, which may be attributed to differences in suture materials: all double Krackow repairs used braided polyester sutures, while Krackow repairs were performed using polyblend polyethylene sutures in seven of eight studies [5, 6, 12, 46, 54, 75, 77]. Suture in‐vitro studies have shown the superiority of polyblend polyethylene compared with braided polyester [4, 11, 79], with the former displaying a 2‐ to 2.5‐fold increase in tensile strength [11, 79].…”

Section: Discussionmentioning

confidence: 99%

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Modified triple Kessler with least risk of elongation among Achilles tendon repair techniques: a systematic review and network meta-analysis of human cadaveric studies

Diniz

Pacheco

Fernandes

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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Purpose Current treatment recommendations emphasize early loading, with preservation of tendon length and physiologic tension. The objective of this systematic review and network meta-analysis was to compare failure load and elongation after cyclic loading of Achilles tendon repair techniques at time-zero. Methods The databases PubMed, CENTRAL and Web of Science were searched for all published in-vitro studies comparing Achilles tendon repair techniques, or augmentation with autografts/biomaterials, and reports of failure load or elongation after cyclic loading. Only studies using human cadaveric Achilles tendons and matched pairs, or randomized specimen allocation, were selected for quantitative synthesis. A network meta-analysis per primary outcome was performed. Results were summarized as P score rankings and their validity was assessed using statistical methods. Results Sixteen studies, comprising 367 tendon repairs, were included. The following repair techniques were used (n = number of studies): Krackow (n = 8), Achillon (n = 4), double Krackow (n = 3), Bunnell (n = 3), Percutaneous Achilles Repair System (n = 3), Percutaneous Achilles Repair System Midsubstance (n = 2), Kessler (n = 3), double Kessler (n = 1), modiied triple Kessler (n = 1), triple bundle (n = 1), a multiilament stainless steel cable-crimp technique (n = 1) and a double loop knot stitch (n = 1). Five studies assessed augmentation with autografts/biomaterials. Regarding the failure load, biomaterial augmented Krackow repairs occupied the irst four positions in the ranking, followed by the multiilament stainless steel cable-crimp and Percutaneous Achilles Repair System Midsubstance techniques. Concerning elongation after cyclic loading, the triple Kessler was ranked irst, followed by the Achillon and Percutaneous Achilles Repair System Midsubstance techniques. A negligible correlation between ranks was found (r s = 0.11; p = 0.75n.s.), meaning that a higher repair tensile strength is not necessarily related to improved performance in regard to avoidance of elongation. Conclusion In the failure load network meta-analysis, biomaterial augmented Krackow repairs ranked highest, but noticeable statistical heterogeneity was found. Regarding elongation with cyclic loading, the modiied triple Kessler stitch showed the highest probability of ranking irst. Level of evidence Level IV.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Modified triple Kessler with least risk of elongation among Achilles tendon repair techniques: a systematic review and network meta-analysis of human cadaveric studies

Diniz

Pacheco

Fernandes

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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“…The study results showed that the application of MSC significantly improved the healing rate of the Achilles tendon compared with the PGA scaffold alone group. Nguyen et al (2020) studied the effect of polyethene (PE) sutures in repairing human Achilles tendon rupture and evaluated the mechanical properties of the suture. The results showed that PE could be used as a medical polymer material to suture human Achilles tendon rupture, but the tensile resistance and degradability are general.…”

Section: Effect Of Pds On Achilles Tendon Repairmentioning

confidence: 99%

Research Progress of Biodegradable Polymers in Repairing Achilles Tendon Injury

et al. 2022

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Achilles tendon injury has become a common sports injury clinically, and its treatment and rehabilitation are essential, while the regenerative capacity of the Achilles tendon in adult mammals is limited. Therefore, it is necessary to promote the repair and remodelling of the Achilles tendon through efficient interventions. Biodegradable polymer materials are one of the most popular in the treatment and repair of soft tissues, ligaments, muscles, and organs injured by organisms to enhance the function of their wounded sites. Thus, it plays a specific role in “compensation” and is widely used in clinical medicine and rehabilitation. This review summarized the progress of poly (ε-caprolactone), polylactic acid, poly (lactic-co-glycolic acid), poly (trimethylene carbonate) (PTMC), and polydioxanone (PDS) in repairing Achilles tendon injury, indicating that the biodegradable polymers have succeeded in improving and treating Achilles tendon injuries. However, some problems such as lack of good affinity with cells and uncontrollable degradation of the biodegradable polymers should be overcome in repairing Achilles tendon injury. Therefore, the development of modified biodegradable polymers to make them an ideal repair material that meets the requirements is vital in improving Achilles tendon injuries. With the continuous development and close cooperation of life sciences and material sciences, excellent materials for repairing Achilles tendon injuries will undoubtedly be produced. The treatment of Achilles tendon injuries will be more straightforward, which will be a boon for many athletes.

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