Biomechanical Evaluation of Patellar Tendon Repair Techniques: Comparison of Double Krackow Stitch with and without Cerclage Augmentation

Background Ruptures of the patellar tendon are rare injuries. Surgical treatment for this injury is mandatory. Hypothesis Gap formation does not differ between the three patellar tendon repair techniques. Study Design Controlled laboratory study. Methods Twelve fresh-frozen cadaveric knees were used to compare three techniques of patellar tendon repairs. The standard suture repair used two Krackow sutures placed in the avulsed patellar tendon, passed through transpatellar drill holes, and secured with the knee in 30° of flexion. In the second group, suture repair was augmented with a No. 5 Ethibond suture. In the third group, suture repair was augmented with a 2.0 Dall-Miles cable. Testing was performed with the specimens mounted to a custom knee jig with the tibia free, simulating the knee moment of a 70-kg person. Each knee was then cycled 250 times at 0.25 Hz. Results Gap formation across the standard suture repair averaged 7.3 mm; across the suture augmentation and cable augmentation groups it averaged 4.9 mm and 3.5 mm, respectively. Conclusions Augmentation of patellar tendon avulsions can decrease gap formation at the repair site, allowing early mobilization. Clinical Relevance Gap formation seen in repair without augmentation could lead to clinical failure with resultant patella alta and extensor mechanism lag.

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Biomechanical evaluation of patellar tendon repair using Krackow suture technique

BioMedical Engineering OnLine ◽

10.1186/s12938-019-0680-z ◽

2019 ◽

Vol 18 (1) ◽

Author(s):

Chen-Yo Yen ◽

Yi-Jung Tsai ◽

Chih-Kun Hsiao ◽

Feng-Chen Kao ◽

Yuan-Kun Tu

Keyword(s):

Patellar Tendon ◽

Tendon Repair ◽

Suture Technique ◽

Biomechanical Evaluation ◽

Krackow Suture

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Biomechanical Evaluation of 4-Strand Flexor Tendon Repair Techniques, Including a Combined Kessler–Tsuge Approach

The Journal Of Hand Surgery ◽

10.1016/j.jhsa.2014.10.055 ◽

2015 ◽

Vol 40 (2) ◽

pp. 229-235 ◽

Cited By ~ 2

Author(s):

Christian Renner ◽

Fernando Corella ◽

Nicole Fischer

Keyword(s):

Flexor Tendon ◽

Tendon Repair ◽

Flexor Tendon Repair ◽

Biomechanical Evaluation ◽

Repair Techniques

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The search for the ideal tendon repair in zone 2: strand number, anchor points and suture thickness

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193413508699 ◽

2013 ◽

Vol 39 (1) ◽

pp. 20-29 ◽

Cited By ~ 32

Author(s):

R. Savage

Keyword(s):

Animal Model ◽

Laboratory Tests ◽

Tendon Repair ◽

Clinical Results ◽

Review Article ◽

Cyclic Motion ◽

Mechanical Factors ◽

Anchor Points ◽

Repair Techniques ◽

The Ideal

This review article examines the mechanical factors involved in tendon repair by sutures. The repair strength, repair stiffness and gap resistance can be increased by increasing the number of core strands and anchor points, by increased anchor point efficiency and the use of peripheral sutures, and by using thicker sutures. In the future, laboratory tests could be standardized to a specific animal model and to a defined cyclic motion programme. Clinical studies support the use of multi-strand core and peripheral sutures, but two-strand core sutures are not adequate to ensure consistently good clinical results. Training surgeons in complex tendon repair techniques is essential.

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Looped suture properties: implications for multistranded flexor tendon repair

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193413516245 ◽

2015 ◽

Vol 40 (3) ◽

pp. 234-238 ◽

Cited By ~ 6

Author(s):

R. Haddad ◽

T. Peltz ◽

N. Bertollo ◽

W. R. Walsh ◽

S. Nicklin

Keyword(s):

Mechanical Properties ◽

Flexor Tendon ◽

Tendon Repair ◽

Relative Effect ◽

Flexor Tendon Repair ◽

Polypropylene Monofilament ◽

Single Suture ◽

Biomechanical Strength ◽

Standard Techniques ◽

Repair Techniques

Multiple-strand repair techniques are commonly used to repair cut flexor tendons to achieve initial biomechanical strength. Looped sutures achieve multiple strands with fewer passes and less technical complexity. Their biomechanical performance in comparison with an equivalent repair using a single-stranded suture is uncertain. This study examined the mechanical properties of double-stranded loops of 3-0 and 4-0 braided polyester (Ticron) and polypropylene monofilament (Prolene). Double loops were generally less than twice the strength of a single loop. Ticron and Prolene had the same strengths, but Ticron was stiffer. The 4-0 double loops had significantly higher stiffness than 3-0 single loops. Increasing the size of sutures had a larger relative effect on strength than using a double-stranded suture. However, a double-strand loop had a larger effect on increasing stiffness than using a single suture of a larger equivalent size. Looped suture repairs should be compared with standard techniques using a thicker single suture.

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