Effect of epitendinous suture augmentation to a double Krackow suture pattern for canine gastrocnemius tendon repair

Abstract

OBJECTIVE To evaluate the effect of a double Krackow suture pattern (DK), with and without epitendinous suture augmentation (ES), in a canine gastrocnemius tendon (GT) model. SAMPLE Paired GTs from 12 adult dog cadavers and 4 control GT. PROCEDURES GTs were assigned to 2 groups (n = 12/group). Transverse tenotomy was performed and repaired with a DK or DK + ES. Yield, peak, and failure force, stiffness, occurrence of 1-and 3-mm gapping, and failure mode were examined. RESULTS Yield, peak, and failure loads were greater for DK + ES. Yield force was 48% greater for DK + ES (mean ± SD, 149.56 ± 53.26 N) versus DK (101.27 ± 37.17 N; P = 0.017). Peak force was 45% greater for DK + ES P < 0.001). Failure force was 47% greater for DK + ES (193.752 ± 31.43 N) versus DK (131.54 ± 22.28 N; P < 0.001). Construct stiffness was 36% greater for DK + ES (P = 0.04). All 12 DK and 10 of 12 DK + ES repairs produced a 1-mm gap, with all DK and 4 DK + ES repairs producing a 3-mm gap (P < 0.001). Loads required to create a 3-mm gap were significantly greater for DK + ES (P < 0.013). Suture breakage occurred in all DK repairs, which differed from DK + ES, where suture breakage (7/12) and tissue failure (5/12; P = 0.037) predominated. CLINICAL RELEVANCE Augmentation of a primary DK repair with an ES significantly improved construct strength in canine GT constructs while increasing loads required to cause 1- and 3-mm gap formation, respectively. ES augmentation is a simple technique modification that can be used to significantly increase construct strength, compared with DK alone.

Biomechanical evaluation of three adjunctive methods of orthopedic tension band‐wire fixation to augment simulated patella tendon repairs in dogs

“…Modifications such as the use of orthopedic wire with a greater area moment of inertia, increased number of twists, or the location of the completed twists may all play a role in construct biomechanics, and subsequently represent an area for investigation. All primary tenorrhaphies were repaired using a core LL and SCES, due to evidence supporting the biomechanical superiority of these techniques for anastomosis of flat tendons 24,25,36 . Although weaker than the 3LP technique, the LL pattern leads to superior apposition of the tendon ends with less bunching at the anastomosis site 24,25,36 .…”

“…All primary tenorrhaphies were repaired using a core LL and SCES, due to evidence supporting the biomechanical superiority of these techniques for anastomosis of flat tendons. 24,25,36 Although weaker than the 3LP technique, the LL pattern leads to superior apposition of the tendon ends with less bunching at the anastomosis site. 24,25,36 Failure caused by core suture pull through can likely be attributed to differing load application to the repair site rather than load application being primarily resisted by the orthopedic wire.…”

“…24,25,36 Although weaker than the 3LP technique, the LL pattern leads to superior apposition of the tendon ends with less bunching at the anastomosis site. 24,25,36 Failure caused by core suture pull through can likely be attributed to differing load application to the repair site rather than load application being primarily resisted by the orthopedic wire. In several constructs, there were two concurrent modes of failure seen during testing, most notably caused by the wire first unraveling causing subsequent suture pull through due to overloading of the primary tendinous repair.…”