Longer stitch interval in the Krackow stitch for tendon graft fixation leads to poorer biomechanical property

Abstract

Purpose: The purpose of this study was to analyze the effects of different intervals between stitch throws on tendon graft fixation with the Krackow stitch. Methods: Forty-four porcine flexor profundus tendons were randomly divided into four groups of 11 specimens each. The Krackow stitch with various stitch intervals (2.5, 5.0, 7.5, and 10.0 mm) were evaluated, and named the K-2.5, K-5.0, K-7.5, and K-10.0 groups, respectively. A braided nonabsorbable suture was used to complete each suture-tendon construct. All specimens were pretensioned to 100 N for three cycles, cyclically loaded from 50 to 200 N for 200 cycles, and then finally loaded to failure. Elongation after cyclic loading, ultimate load to failure, and the mode of failure were recorded. Results: There were significant differences in elongation after cyclic loading among the K-2.5 (31% + 5%), K-5.0 (32% + 4%), K-7.5 (34% + 5%), and K-10.0 (41% + 8%) groups (p ¼ 0.004); the post hoc analysis showed significantly smaller values in the K-2.5 and K-5.0 groups than in the K-10.0 group (p ¼ 0.002 and 0.003, respectively). The stitch interval was correlated with elongation after cyclic loading (r ¼ 0.52, p < 0.001). Ultimate loads to failure and cross-sectional area were not significantly different across the four groups. Conclusion: The Krackow stitch with stitch intervals of 2.5 and 5.0 mm had significantly smaller elongation after cyclic loading than with an interval of 10.0 mm in this porcine biomechanical study. The stitch interval was moderately correlated with elongation after cyclic loading.

Jigless knotless internal brace versus other open Achilles tendon repair under progressive rehabilitation protocol: A biomechanical study

“…Second, the study was conducted on porcine Achilles tendons, not the cadaveric tendons; however, porcine tendon has been adopted in numerous biomechanical works to evaluate the varied tendon repair methods or xation techniques in tendon grafts [32,49]. Besides, we found a similar trend in our comparisons between the 4sK and TBS as well as similar survival cycles for the 4sK as in previous studies [30,33].…”

“…Three locking loops were placed 5 mm in each strand and at each end of the tendon with the Hi-Fi® Suture (Conmed). A 5 mm stitch interval was chosen because stitch intervals of 5.0 mm were found to have signi cantly smaller elongation compared with other longer stitch intervals after cyclic loading [32]. The loops were tightened to obtain end-to-end repair after three surgeon's knots were tied (Fig.…”

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

“…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. Numerous biomechanical studies have been conducted to obtain reliable suture-tendon constructs, 1 , 3 , 4 , 7 , 8 , 11 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 and using the Krackow suture technique accompanied with a high-tensile strength suture is currently the most popular method. Recently, a high-tensile strength tape was developed, which was reported to have greater knot security, ultimate load to failure, and tensile stiffness as compared to the high-tensile strength round core suture.…”

“…The parameters in the biomechanical testing protocol were in accordance to previous studies. 1,4,9,[15][16][17][18][19][20][21] All specimens were initially pretensioned to 100 N at a rate of 100 mm/min for 3 cycles and then preloaded to 50 N for 1 minute. After that, each specimen was cyclically loaded between 50 and 200 N with a cross-head speed of 200 mm/min for 200 cycles.…”

Does using high-tensile strength tape improve the fixation strength in tendon graft fixation with needleless suture wrapping techniques compared to a suture?

“…20 In accordance with previous studies. [14][15][16][21][22][23][24][25] the entire tendons were excised from adult male fresh porcine (mean age, 2 years) hindleg trotters and were cut into equal lengths (18 cm). Next, the tendons were evaluated carefully for possible degenerative or pathologic lesions.…”