Hamstring Graft Preparation Using a Modified Rolling Hitch Technique

Hong, Chih-Kai; Chang, Chih-Hsun; Chiang, Chen‐Hao; Jou, I‐Ming; Su, Wei-Ren

doi:10.1016/j.eats.2014.01.010

Cited by 22 publications

(12 citation statements)

References 3 publications

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“…3,4,13 It is clearly not the quickest approach and the desire for a more efficient yet effective option has led to the development of many other stitch configurations. 1,6,8,14 The goals of a simpler and quicker construct are achieved by the SpeedTrap, WhipKnot, and Loop-in-loop constructs. Additionally considering tissue damage during the load to failure testing demonstrates that these three techniques are the least traumatic of those tested.…”

Section: Discussionmentioning

confidence: 99%

“…This can be time-consuming, may damage the tendon, and place the surgical personnel at risk for needle sticks. 1 The Krackow stitch 2 has long been a gold standard for this purpose and variations of this stitch have not shown different failure loads. 3 Sakaguchi et al 4 compared different needle based techniques and found that the Krackow stitch was superior to both the whipstitch and the baseball stitch.…”

Section: See Commentary On Page 1170mentioning

confidence: 99%

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A Biomechanical Comparison of Six Suture Configurations for Soft Tissue–Based Graft Traction and Fixation

Barber

Howard

Piccirillo

et al. 2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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The purpose of this study was to compare 6 different graft fixation techniques to determine the preparation speed, fixation security, biomechanical strength, and resultant tissue trauma. Methods: Six different techniques (10 samples each): #2 OrthoCord Krackow stitch, #2 FiberWire Krackow stitch, SpeedTrap, WhipKnot, Loop-in-loop stitch were created in the distal 3 cm of 9 cm bovine flexor tendons. The proximal 3 cm tendon segment was clamped in a testing machine and the distal suture ends secured by pneumatic grips. 3 preload cycles (10N-100N) and 50N static load was followed by 500 cycles (50N-200N) and then loaded to failure. Graft preparation times, 100 and 500 cycle displacement, maximum failure load, stiffness, and failure mode were recorded. Results: Representative graft preparation times were: OrthoCord Krackow (247s), FiberWire Krackow (401s), FiberLoop (177s), SpeedTrap (42s), WhipKnot (39s), Loopin-loop (45s). No WhipKnots survived cyclic loading. 100 cycle displacements were: OrthoCord Krackow (11.5 AE 3.9 mm), FiberWire Krackow (8.9 AE 1.2 mm), FiberLoop (14.2 AE 6.1 mm), SpeedTrap (8.8 AE 2.5 mm), Loop-in-loop (10.4 AE 2.9 mm). FiberLoop displaced significantly more than all others (P ¼ .016). Maximum failure loads were: OrthoCord Krackow (364 AE 24N), FiberWire Krackow (375 AE 45N), FiberLoop (413 AE 95N), SpeedTrap (437 AE 65N), WhipKnot (153 AE 42N), Loop-in-loop (329 AE 112N). The most common failure mode was suture breaking. FiberWire containing constructs (Krackow and FiberLoop) shredded or cut through ("cheese wiring") prior to failure in a majority. Conclusions: SpeedTrap, WhipKnot and Loop-in-loop were quickest to create (under 1 minute). The Krackow, SpeedTrap, WhipKnot, and Loop-in-Loop did not damage the tendon during cyclic loading. SpeedTrap and Krackow had the least displacement. FiberLoop displaced more than all other groups (P ¼ .016). No WhipKnot completed cyclic loading. The SpeedTrap (437N) and FiberLoop (413N) had the highest ultimate strength. Clinical Relevance: While the SpeedTrap and FiberLoop are the strongest techniques, the FiberLoop shreds the tendon, displaced the most, and took longer to create. Based on these results, the SpeedTrap demonstrates the best overall performance.

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Section: Discussionmentioning

confidence: 99%

Section: See Commentary On Page 1170mentioning

confidence: 99%

A Biomechanical Comparison of Six Suture Configurations for Soft Tissue–Based Graft Traction and Fixation

Barber

Howard

Piccirillo

et al. 2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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show abstract

“…Once achieving a strong fixation strength, early rehabilitation can be allowed before the completion of biologic healing in the graft tunnel. 1 , 2 , 3 , 4 In past decades, various suture techniques have been addressed for tendon graft fixation 1 , 3 , 4 , 5 , 6 , 7 , 8 ; among these techniques, the Krackow suture 6 remains the most popular because it provides superior biomechanical properties. 9 , 10 , 11 …”

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confidence: 99%

The Biomechanical Properties of a High-Tensile Strength Tape for Tendon Graft Fixation Using the Krackow Configuration

Hong

Hsu

Kuan

et al. 2020

Arthroscopy, Sports Medicine, and Rehabilitation

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To compare the biomechanical properties of a high-tensile strength suture with the high-tensile strength tape for tendon graft fixation. Methods: A total of 24 porcine tendons were used and were randomly divided into 2 groups. Two kinds of suture materials, a braided nonabsorbable high-strength suture (group S) and a high-tensile strength tape (group T), were used to complete 3 pairs of Krackow stitches on the tendons. Each specimen was pretensioned to 100 N for 3 cycles, cyclically loaded from 50 to 200 N for 200 cycles, and finally loaded to failure. Elongation after cyclic loading, ultimate failure load, and the mode of failure were recorded. Results: The elongation after cyclic loading between group S (26% AE 5%) and group T (24% AE 5%) were not significantly different (P ¼ .378). The ultimate failure loads in group T (400 AE 38 N) were significantly greater than those in group S (358 AE 21 N) (P ¼ .010). All specimens failed because of suture material breakage. Conclusions: Compared with the braided nonabsorbable high-strength suture, the high-tensile strength tape had similar elongation values after cyclic loading, but significantly greater ultimate failure load in this porcine in vitro biomechanical model. Clinical Relevance: A secure suture-tendon construct is especially important when a post-tie fixation technique is used because the mitigating construct may potentially lead to graft loosening and affect graft healing.

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“…In most cases of the single-tendon technique, the ACL graft is formed by a closed tendon loop, which must be secured with sutures at the ends of the graft [6]. The type of loop can vary and different techniques of folding the graft [7][8][9]. Securing its ends with sutures have been described and tested [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

The single-suture technique for anterior cruciate ligament graft preparation provides similar stability as a three-suture technique: a biomechanical in vitro study in a porcine model

Theopold¹,

Schleifenbaum

Georgi³

et al. 2020

Arch Orthop Trauma Surg

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Purpose Numerous techniques have been described for the tibial-sided graft preparation in anterior cruciate ligament (ACL) reconstruction. The use of less suture material for graft preparation is thought to improve ingrowth and to reduce the risk for infection. At the same time, the suture construct should be strong enough to resist the surgeon's pull during tensioning of the transplant. Methods In total, 39 fresh-frozen procine deep flexor tendons were used and prepared as four-strand grafts. In the three-suture group (n = 19), graft preparation was performed using three tibial-sided sutures, with each tendon end sutured separately. In the one-suture group (n = 20), a modified graft preparation using only one tibial-sided suture was applied. Each sample underwent load-to-failure testing (N max ) after cyclic pre-loading. To estimate intraoperative tension forces acting on the tibial-sided suture constructs, the maximal tension force of 26 volunteers on such a construct was measured using a load cell. Results The biomechanical testing of the two different suture constructs showed a significantly higher load-to-failure for the three-suture group (711 N ± 91 N) compared to the one-suture group (347 N ± 24 N) (p = 0.0001). In both groups, the mode of failure was a tear of the suture in all samples. A failure of the suture-tendon interface was not observed in any case. The median maximal tension force on the construct applied by the 26 volunteers was 134 N (range 73-182 N). Conclusion The presented single-suture tendon graft preparation resisted to smaller failure loads than the conventional three-suture technique. However, no failures in the suture-tendon interface were seen and the failure loads observed were far beyond the tension forces that can be expected intraoperatively. Hence, the single-suture graft preparation technique may be a valuable alternative to the conventional technique.Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Hamstring Graft Preparation Using a Modified Rolling Hitch Technique

Cited by 22 publications

References 3 publications

A Biomechanical Comparison of Six Suture Configurations for Soft Tissue–Based Graft Traction and Fixation

A Biomechanical Comparison of Six Suture Configurations for Soft Tissue–Based Graft Traction and Fixation

The Biomechanical Properties of a High-Tensile Strength Tape for Tendon Graft Fixation Using the Krackow Configuration

The single-suture technique for anterior cruciate ligament graft preparation provides similar stability as a three-suture technique: a biomechanical in vitro study in a porcine model

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