The Loop ’n’ Tack Knot: Biomechanical Analysis of a Novel Suture Technique for Proximal Biceps Tenodesis

Abstract

Background: Secure tendon grasping is critical to the success of any tenodesis procedure. Several techniques currently used for tendon grasping can result in longitudinal splitting of the tendon, causing construct failure and failure of the tenodesis. Purpose: To compare the Loop ’n’ Tack knot as a tendon-grasping technique with other common suture techniques. We investigated the biomechanical strength and mode of failure. Study Design: Controlled laboratory study. Methods: Eleven matched pairs of proximal biceps were harvested from fresh-frozen cadaveric shoulders. One tendon from each pair was stitched using 1 of 4 different techniques. The suture techniques evaluated included the Loop ’n’ Tack with 2 different types of high-strength nonabsorbable suture, a double half-racking stitch, and a Krakow stitch. Samples were cyclically loaded between 5 and 20 N for 100 cycles, followed by a pull to failure at 33 mm/s. Results: The Loop ’n’ Tack techniques were equivalent to the double half-racking and Krakow techniques for load to ultimate failure ( P = .817 and P = .984, respectively). The double half-racking technique was the stiffest construct, which was significantly greater than the second-stiffest group, the Loop ’n’ Tack method with both FiberLink suture ( P = .012) and SutureTape ( P = .002), which had greater stiffness than the Krakow group ( P < .001). The most common failure mode for the Loop ’n’ Tack stitch was suture breakage compared with the Krakow and double half-racking methods, where the most common mode of failure was suture pullout from the tendon ( P < .001). Conclusion: Biomechanical testing found that the Loop 'n’ Tack techniques had similar ultimate load to failure values when compared with the double half-racking and Krakow methods. Mode-of-failure analysis showed that the Loop 'n’ Tack construct typically failed by suture breakage, whereas the other techniques failed by suture pullout. Clinical Relevance: The Loop 'n’ Tack technique allows for secure grasping of tissue without the need for externalization of the tendon. This technique may be beneficial in compromised or poor-quality tissue without reducing overall pullout strength when compared with a standard half-racking or Krakow stitch.

The Lark Loop Used for Proximal Biceps Tenodesis: An All-Arthroscopic Technique

“…A kind of all-arthroscopic tenodesisdthe loop 'n' tack techniquedwas first reported by Duerr et al 10 using a FiberSnare. Later, Acosta et al 12 conducted an in vitro biomechanical study and found that the loop 'n' tack method had an ultimate load to failure similar to that of the Krackow stitch. Therefore, the loop 'n' tack technique has proved safe and effective.…”

“…Duerr et al 10 first proposed the "loop 'n' tack knot" biceps tenodesis technique, applied in all-arthroscopic LHBT tenodesis, with satisfactory clinical outcomes. 11 However, this simple technique required specialty sutures, FiberSnare or FiberLink (Arthrex, Naples, FL), 10,12 which were commercially unavailable in many regions and limited the further promotion of this technique. Therefore, in this article, we propose a suture techniquedthe lark-loop techniquedthat resembles the configuration of the lark's head knot, based on an alteration of the loop 'n' tack technique.…”

Biomechanical Analysis of Arm Manipulation in Tai Chi

“…Acosta and others used the three-dimensional image analysis method to analyze the kinematic characteristics of Chinese professional football players throwing long-distance out of bounds, and came to the conclusion that they want to throw long-distance and high-quality out of bounds. Athletes need to mobilize their body muscles as much as possible for orderly swing from bottom to top, and can release the ball within a reasonable and effective angle range [7]. Lee and others used six optical cameras to obtain the lower limb technical action images of 10 men's volleyball players during the take-off period of front and rear buckle.…”

Biomechanical Analysis of Lark‐Loop, Lasso‐Loop and Krackow Suture Technique in Tenodesis

“…14 Although the classic Krackow suture technique shows superior biomechanical properties for biceps tendon fixation, it is not easy to complete under arthroscopy. 15 Therefore, secure tendon grasping ability of the suture techniques is critical for successful arthroscopic tenodesis in order to obtain a lower incidence of Popeye deformity of the upper arm with endoscopic fixation. The Lark-Loop stitch, newly presented in 2022 by Zhou et al 16 constructs a Lark's head knot, holding tendon tissue with the two suture ends piercing through the middle portion of the tendon.…”