Comparative Study of Biomechanical Properties between Needled Suture and Needleless Suture in Multi-Strand Tendon Graft Model

2021 ◽  
Vol 104 (9) ◽  
pp. 1447-1451
Keyword(s):  
Testing Machine ◽  
Biomechanical Properties ◽  
Tendon Graft ◽  
Suture Technique ◽  
Biomechanical Study ◽  
Modes Of Failure ◽  
Tendon Elongation ◽  
Significant Difference ◽  
Load To Failure ◽  
Distraction Force

Objective: To compare the biomechanical properties of the Chinese finger (CF) suture, a needleless suture technique, with the baseball stitch (BS) suture, a needled suture technique, in a multi-strand model by using a 4-strand tendon model. Additionally, the BS was compared with the serial rolling hitch (RH), a locking needleless suture technique. Materials and Methods: 4-strand grafts, made from two 20-cm fresh porcine toe extensors, were used in all three groups. After the grafts were sutured, pretension was applied with a load of 100-N distraction force for five minutes. After the tendon elongation was measured before and after the pretension, the distraction force was continued until the constructed graft failed. Stress-strain relationship graphs were recorded by universal testing machine (UTM), distributing to the calculation of percentage on tendon elongation, stiffness, and load-to-failure. Results: The BS had significantly higher load of failure than the CF (p=0.001) but no significant difference when compared with the RH. Comparing between BS, CF, and RH, there were no significant difference in stiffness and percentage of tendon elongation. In modes of failure, there was evidence of knot slipping in CF in six of six cases and graft strangulation in RH in four of six cases. Conclusion: Multi-strand model BS, a needled suture, had a higher load to failure than CF, a needleless suture. Moreover, needleless sutures had serious modes of failure, which were knot slipping and strangulation of graft by the suture material. Therefore, needleless suture technique for multi-strand tendon graft preparation was not recommended. Keywords: Tendon preparation; Multi-Strand; Needled suture; Needleless suture; Chinese finger; Baseball stitch; Rolling Hitch; Biomechanical study; Graft elongation; Load to failure

scholarly journals Sternoclavicular Joint Reconstruction Fracture Risk Is Reduced With Straight Drill Tunnels and Optimized With Tendon Graft Suture Augmentation

2019 ◽  
Vol 7 (4) ◽  
pp. 232596711983826 ◽  
Author(s):  
Frank Martetschläger ◽  
Franziska Reifenschneider ◽  
Nicole Fischer ◽  
Coen A. Wijdicks ◽  
Peter J. Millett ◽  
...  
Keyword(s):  
Testing Machine ◽  
Primary Stability ◽  
Biomechanical Properties ◽  
Tendon Graft ◽  
Sternoclavicular Joint ◽  
Graft Material ◽  
Load To Failure ◽  
Posterior Translation ◽  
Drill Holes ◽  
Suture Tape

Background: Despite the rare entity of sternoclavicular joint (SCJ) instability, a variety of different reconstruction techniques for SCJ dislocations have been described. A technique with oblique drilling has been proposed to reduce intraoperative risks. Purpose: To biomechanically investigate different cerclage reconstruction techniques and the benefit of additional reinforcement using suture tape. Study Design: Controlled laboratory study. Methods: Reconstructed artificial bone specimens were mounted on a mechanical testing machine. They were subjected to anterior and posterior translation, analyzing ultimate strength, displacement, stiffness, and elongation. For stage 1, different angulations of the drill tunnels through the sternum and clavicle were compared. Straight drill tunnels from anterior to posterior were compared with 45° oblique drill tunnels. For stage 2, three different materials for cerclage reconstruction were compared: (1) suture tape alone (FT group), (2) tendon graft alone (tendon group), and (3) tendon graft with suture tape augmentation (tendon+FT group). Results: For the FT group, in the anterior and posterior directions, straight drill holes resulted in a significantly higher load to failure (936.9 ± 122.5 N) compared with oblique ones (434.5 ± 20.2 N) ( P < .0001). During cyclic testing, all specimens with straight drill holes survived the 5- to 550-N step, while all specimens with oblique ones failed during the 5- to 450-N step. Analyzing the graft material choice, the mean load to failure was 556.6 ± 174.3 N for the tendon group, 936.9 ± 122.5 N for the FT group, and 767.0 ± 110.7 N for the tendon+FT group ( P = .089). The stiffness of the tendon+FT group was significantly lower than that of the FT group and significantly higher than that of the tendon group. Conclusion: Oblique tunnel placement during SCJ reconstruction, while reducing the intraoperative risk, results in decreased primary stability of the construct. Tendon graft reconstruction with suture tape augmentation leads to enhanced stability and optimizes biomechanical properties of the construct. Clinical Relevance: The surgical technique with straight drill holes has superior initial biomechanical properties and may likewise produce superior clinical outcomes in the treatment of SCJ instability. Suture tape augmentation can provide additional stability to reconstruction procedures.

scholarly journals Interference Screw Versus Suture Anchors for Femoral Fixation in Medial Patellofemoral Ligament Reconstruction: A Biomechanical Study

2021 ◽  
Vol 9 (3) ◽  
pp. 232596712198928
Author(s):  
Heath P. Gould ◽  
Nicholas R. Delaney ◽  
Brent G. Parks ◽  
Roshan T. Melvani ◽  
Richard Y. Hinton
Keyword(s):  
Medial Patellofemoral Ligament ◽  
Interference Screw ◽  
Biomechanical Study ◽  
Graft Fixation ◽  
Mpfl Reconstruction ◽  
Suture Anchors ◽  
Femoral Fixation ◽  
Significant Difference ◽  
Load To Failure ◽  
The Mean

Background: Femoral-sided graft fixation in medial patellofemoral ligament (MPFL) reconstruction is commonly performed using an interference screw (IS). However, the IS method is associated with several clinical disadvantages that may be ameliorated by the use of suture anchors (SAs) for femoral fixation. Purpose: To compare the load to failure and stiffness of SAs versus an IS for the femoral fixation of a semitendinosus autograft in MPFL reconstruction. Study Design: Controlled laboratory study. Methods: Based on a priori power analysis, a total of 6 matched pairs of cadaveric knees were included. Specimens in each pair were randomly assigned to receive either SA or IS fixation. After an appropriate reconstruction procedure, the looped end of the MPFL graft was pulled laterally at a rate of 6 mm/s until construct failure. The best-fit slope of the load-displacement curve was then used to calculate the stiffness (N/mm) in a post hoc fashion. A paired t test was used to compare the mean load to failure and the mean stiffness between groups. Results: No significant difference in load to failure was observed between the IS and the SA fixation groups (294.0 ± 61.1 vs 250.0 ± 55.9; P = .352), although the mean stiffness was significantly higher in IS specimens (34.5 ± 9.6 vs 14.7 ± 1.2; P = .004). All IS reconstructions failed by graft pullout from the femoral tunnel, whereas 5 of the 6 SA reconstructions failed by anchor pullout. Conclusion: In this biomechanical study using a cadaveric model of MPFL reconstruction, SA femoral fixation was not significantly different from IS fixation in terms of load to failure. The mean load-to-failure values for both reconstruction techniques were greater than the literature-reported values for the native MPFL. Clinical Relevance: These results suggest that SAs are a biomechanically viable alternative for femoral-sided graft fixation in MPFL reconstruction.

A COMPARATIVE BIOMECHANICAL STUDY OF THE LOOPED SQUARE SLIP KNOT AND THE SIMPLE SURGICAL KNOT

Hand Surgery ◽  
2006 ◽  
Vol 11 (01n02) ◽  
pp. 93-99 ◽  
Author(s):  
Surut Jianmongkol ◽  
Geoffrey Hooper ◽  
Weerachai Kowsuwon ◽  
Tala Thammaroj
Keyword(s):  
Ultimate Strength ◽  
Hand Surgery ◽  
Biomechanical Properties ◽  
Biomechanical Study ◽  
Skin Closure ◽  
Significant Difference ◽  
Mode Of Failure ◽  
Repetitive Loading ◽  
Slip Knot

The looped square slip knot was introduced as a technique for skin closure to avoid the use of sharp instruments in suture removal after hand surgery. We compared the biomechanical properties of this knot with the simple surgical square knot. The ultimate strength of the looped square slip knot was significantly (p = 0.015) higher than the simple surgical knot. There was no significant difference between the two knots in mode of failure. Knot slippage or suture breakage did not occur in any samples when testing security by repetitive loading. Therefore, the looped square slip knot is a safe and convenient alternative to the two-throw surgical knot for use in hand surgery.

scholarly journals Continuous-Loop Tape Technique Has Greater Stiffness and Less Elongation Compared With Tied-Suture Fixation of Full-Thickness All–Soft Tissue Quadriceps Tendon Autografts

2021 ◽  
Vol 9 (11) ◽  
pp. 232596712110541
Author(s):  
Christopher M. Gibbs ◽  
Philipp W. Winkler ◽  
Robert T. Tisherman ◽  
Calvin K. Chan ◽  
Theresa A. Diermeier ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Ultimate Load ◽  
Quadriceps Tendon ◽  
Tendon Graft ◽  
Suture Technique ◽  
Suture Fixation ◽  
Full Thickness ◽  
Quadriceps Tendon Graft ◽  
Significant Difference ◽  
Permanent Elongation

Background: Many graft fixation techniques are utilized for full-thickness soft tissue quadriceps tendon autografts during anterior cruciate ligament reconstruction (ACLR). Purpose: To determine the tensile properties of all–soft tissue quadriceps tendon graft fixation using a tied-suture versus continuous-loop tape technique. It was hypothesized that the continuous-loop tape technique would have less cyclic elongation and greater ultimate load to failure and stiffness compared with a commonly used tied-suture technique. Study Design: Controlled laboratory study. Methods: Sixteen fresh-frozen human knee specimens were used to harvest a full-thickness all–soft tissue quadriceps tendon graft; half were secured using a Krackow suture technique with 2 braided sutures, and half were secured using a continuous-loop tape suspensory fixation button with a rip-stop stitch. Cyclic and permanent elongation, toe- and linear-region stiffness, and ultimate load were determined. Statistical analysis was performed at P <.05. Results: The tied-suture fixation group demonstrated significantly higher permanent elongation (11.7 ± 3.6 vs 4.2 ± 1.0 mm, P < .001) and cyclic elongation (5.9 ± 1.3 vs 2.0 ± 0.4 mm, P < .001) compared with the continuous-loop tape fixation group. There was a significantly higher linear-region stiffness with continuous-loop tape fixation compared with tied-suture fixation (98.8 ± 12.7 vs 85.5 ± 7.5 N/mm, P = .022). No significant difference in ultimate load between groups (517.1 ± 149.2 vs 465.6 ± 64.6 N) was found. The mode of failure was tendon pull-through for the continuous-loop tape group and suture breakage in the tied-suture group ( P < .001). Conclusion: Continuous-loop tape fixation is superior to tied-suture fixation in regard to elongation and stiffness for all–soft tissue quadriceps tendon grafts, but there was no significant difference in ultimate load. Clinical Relevance: Continuous-loop tape fixation of all–soft tissue quadriceps tendon grafts for ACLR is a valid technique with superior tensile properties.

scholarly journals Biomechanical Evaluation of Proximal Hamstring Repair: All-Suture Anchor Versus Titanium Suture Anchor

2020 ◽  
Vol 8 (1) ◽  
pp. 232596711989292 ◽  
Author(s):  
Alexander Otto ◽  
Alyssa M. DiCosmo ◽  
Joshua B. Baldino ◽  
Julian Mehl ◽  
Elifho Obopilwe ◽  
...  
Keyword(s):  
Cyclic Loading ◽  
Suture Anchor ◽  
Testing Machine ◽  
Optical Tracking ◽  
Rank Test ◽  
Suture Anchors ◽  
Posterior Aspect ◽  
Significant Difference ◽  
Load To Failure ◽  
Proximal Hamstring

Background: Proximal hamstring avulsions are severe tendon injuries and are commonly sports-related. Open and endoscopic techniques as well as different anchor configurations have already been described for proximal hamstring repair. Novel all-suture anchors have been developed to provide decreased bone loss during placement and reduced occupied bone volume when compared with titanium suture anchors. Hypothesis: Complete proximal hamstring avulsions repaired with all-suture anchors will demonstrate equal load to failure and comparable displacement under cyclic loading when compared with titanium suture anchors. Study Design: Controlled laboratory study. Methods: Complete proximal hamstring avulsions were created in 18 paired cadaveric specimens (mean ± SD age, 63.0 ± 10.4 years). Either all-suture anchors or titanium suture anchors were used for repair. Cyclic loading from 10 to 125 N at 1 Hz was performed for 1500 cycles with a material testing machine. Displacement was assessed along anterior and posterior aspects of the tendon repair with optical tracking. Specimens were loaded to failure at a rate of 120 mm/min. Displacement, load to failure, and repair construct stiffness were compared between matched pairs with the Wilcoxon signed-rank test. Correlations were determined by Spearman rho analysis. Results: The all-suture anchors showed significantly higher load-to-failure values when compared with the titanium anchor repairs (799.64 ± 257.1 vs 573.27 ± 89.9 N; P = .008). There was no significant difference in displacement between all-suture anchors and titanium suture anchors at the anterior aspect (6.60 ± 2.2 vs 5.49 ± 1.1 mm; P = .26) or posterior aspect (5.87 ± 2.08 vs 5.23 ± 1.37 mm; P = .678) of the repaired hamstring tendons. Conclusion: All-suture anchors demonstrated similar displacement and superior load to failure when compared with titanium suture anchors. Clinical Relevance: The results of this study suggest that all-suture anchors are an equivalent alternative to titanium suture anchors for proximal hamstring avulsion repair.

Biomechanical properties of expander compared with conventional screws

2002 ◽  
Vol 97 (3) ◽  
pp. 346-349 ◽  
Author(s):  
Aziz Rassi-Neto ◽  
Antonio Shimano
Keyword(s):  
Maximum Load ◽  
Biomechanical Properties ◽  
Biomechanical Study ◽  
Intergroup Difference ◽  
Content Type ◽  
Significant Difference ◽  
Group 2 ◽  
The Comparative Study ◽  
Screw Group ◽  
Fine Print

Object. A pullout strength biomechanical study was performed in 20 fresh swine vertebral bodies in which titanium expander (Group 1) and conventional screws (Group 2) were placed. Methods. The screws were inserted into the anterosuperior portion of the anterior spine, and assessment was performed after application of loads. The expander screw is composed of two parts: 1) a cover with an external portion comprising tight thin threads; and 2) a compact internal screw inserted through the cover that allows expansion. In the comparative study between the screws in Groups 1 and 2 maximum load was assessed, and the intergroup difference was significant (p = 0.00001 [t-test]); regarding load at the elasticity threshold, a significant difference was also observed (p = 0.0063). With regard to rigidity (stiffness), there was a tendency in both groups toward significance (p = 0.069). With regard to absorbed energy in the elastic phase, statistical analysis showed a significant intergroup difference (p = 0.00439). The expander screw showed a greater load-bearing capacity than the conventional screw. Adhesion to bone in relation to the applied load and displacement was greater (significant tendency) in the expander screw group than in the conventional screw group. Conclusions. The expander screws exhibited a greater capacity to absorb energy in the elastic phase. They adhered better to bone, were easy to insert, and, if necessary, were simple to remove.

scholarly journals Similar biomechanical properties of four tripled tendon graft models for ACL reconstruction

2021 ◽  
Author(s):  
Davide Pavan ◽  
Federica Morello ◽  
Francesco Monachino ◽  
Giuseppe Rovere ◽  
Lawrence Camarda ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Testing Machine ◽  
Thermoelastic Stress ◽  
Fatigue Loading ◽  
Biomechanical Properties ◽  
Simultaneous Increase ◽  
Full Field ◽  
Biomechanical Behavior ◽  
Significant Difference ◽  
Group 2

Abstract Purpose The present study tested and compared the biomechanical properties of four different triplicate graft tendon techniques. Methods 32 tripled tendons from the common extensor muscle of bovine fingers were tested on a material testing machine, passing the end loop over a metal rod of a clevis connected to the load cell on the upper side, and fixing the lower end to a clamp. The samples were divided into four groups: (A) tripled with a free end sutured only to one of the two fixed bundles (B) tripled with a free end positioned between the two fixed strands and sutured to both (C) tripled with an S-shape and all the three strands sutured together at the upper and lower extremities of the graft (D) partially quadrupled with the free end sutured together with the other three bundles at the upper extremity. Each sample was pretensioned at 50 N for 10 min and then subjected to 1000 load control cycles between 50 and 250 N. Finally, each sample was subjected to a load to failure test. Authors also present some preliminary results on the feasibility of a non-contact and full-field Thermoelastic Stress Analysis technique, based on Infrared Thermography, to evaluate the level of stress on the whole graft, and hence on each strand, during fatigue loading. Results Eighty five percent of the samples failed at the level of the clamp. The cyclical elongation progressively decreased in all the samples and there was a simultaneous increase in stiffness. An increased stiffness was noted between Group 2 vs Group 3 and Group 2 vs Group 4 at the 500th and 1000th cycle. The failure loads were as follows: (a) 569.10 N, (b) 632.28 N, (c) 571.68 N, (d) 616.95 N. None of the parameters showed a statistically significant difference between the four groups. Conclusion This study reported similar biomechanical behavior of four different models of tripled grafts suitable for ACL reconstruction. In addition, the biomechanics of overall tripled tendon grafts seems more affected by the viscoelastic property of the tendon itself rather than the preparation method.

scholarly journals Lateral Translation of the Patella in MPFC Reconstruction: A Biomechanical Study of Three Surgical Techniques (210)

2021 ◽  
Vol 9 (10_suppl5) ◽  
pp. 2325967121S0031
Author(s):  
William Cregar ◽  
Hailey Huddleston ◽  
Elizabeth Shewman ◽  
Brian Cole ◽  
Adam Yanke
Keyword(s):  
Soft Tissue ◽  
Knee Flexion ◽  
Functional Disability ◽  
Articular Surface ◽  
Testing Machine ◽  
Surgical Techniques ◽  
Biomechanical Study ◽  
Mpfl Reconstruction ◽  
Tensile Testing Machine ◽  
Significant Difference

Objectives: Recurrent patellar instability (RPI) is a common knee disorder and can lead to chronic pain and functional disability. Surgically addressing recurrent patella instability has classically focused on reconstruction of the MPFL, which has widely become the standard of care either in isolation or concomitantly with other patellar realignment procedures. Complications following MPFL reconstruction include patellar fracture, articular surface penetration, and physeal injury in skeletally immature patients. In an effort to avoid these, other surgical techniques have been described. While these alternative MPFC reconstructions have anatomical support and the theoretical potential to reduce complications, it is unknown whether differences exist in lateral patellar translation and thus their effectiveness in adequately stabilizing the patella. The purpose of this study was to investigate whether differences exist in the ability to prevent lateral patellar translation between three distinct medial patellar stabilizing surgical procedures at varying knee flexion angles. Methods: Six cadaveric knee specimens were dissected, potted, and placed in a customized jig for testing. The quadricep muscle groups were separated into three components and loaded with a total of 175 N in anatomic directions using a weighted pulley system. Lateral patellar displacement was measured at 0°, 10°, 20°, 30°, 45°, 60°, and 90° of knee flexion using a tensile testing machine with a 20 N lateral force applied to the patella. Each specimen was tested with the MPFC intact and sectioned, and after each of the three reconstruction techniques: medial patellofemoral ligament (MPFL) reconstruction, hybrid (proximal medial patellar restraints - PMPR) reconstruction, and medial quadriceps-tendon femoral (MQTFL) reconstruction. Statistical analysis used the Friedman and Wilcoxon rank sum tests due to non-normally distributed data. Results: There was significantly increased lateral patellar displacement following MPFC sectioning when compared to the intact state in early degrees of flexion (10° to 30°) (p<0.05). All three reconstruction groups adequately restored patella stability and reduced lateral patellar displacement following medial soft tissue sectioning by 42%, 41% and 33% following MPFL, Hybrid and MQTFL reconstruction, respectively, from 0° to 30° of knee flexion (p<0.05 for each reconstruction group). When compared to the native, intact medial restraints group, all three reconstruction groups demonstrated reduced patella translation at full knee extension, while the MPFL and Hybrid reconstruction groups additionally demonstrated significant reduction of patella translation at 10° of flexion as well (p<0.05). When comparing patella displacement between reconstruction groups, no significant difference was observed at any degrees of flexion between the three groups. Conclusions: This biomechanical cadaveric study demonstrates the efficacy of three different MPFC reconstruction techniques in restoring patella stability following MPFC sectioning, especially at lower knee flexion angles where the medial soft tissue restraints play a more important role. Although all three reconstruction groups demonstrated less patella translation than the native MPFL intact knee, MPFL reconstruction appears to provide the most robust patella stabilization, whereas MQTFL reconstruction may be the most forgiving construct. Future clinical studies are needed to investigate the clinical correlation of these findings.

scholarly journals Radial Tears of the Lateral Meniscus—Two Novel Repair Techniques: A Biomechanical Study

2018 ◽  
Vol 6 (4) ◽  
pp. 232596711876808 ◽  
Author(s):  
Zachary C. Stender ◽  
Allison M. Cracchiolo ◽  
Michael P. Walsh ◽  
David P. Patterson ◽  
Matthew J. Wilusz ◽  
...  
Keyword(s):  
Cyclic Loading ◽  
Lateral Meniscus ◽  
Suture Technique ◽  
Biomechanical Study ◽  
Partial Meniscectomy ◽  
Suture Repair ◽  
Load To Failure ◽  
The Cross ◽  
Inside Out ◽  
Repair Techniques

Background: A common treatment for radial tears of the meniscus has historically been partial meniscectomy. Owing to the poor outcomes associated with partial meniscectomy, repair of the meniscus is an important treatment option. It is important to evaluate different repair techniques for radial tears of the meniscus. Purpose/Hypothesis: The purpose of this study was to evaluate 2 novel techniques to repair radial tears of the lateral meniscus. The 2 techniques were compared biomechanically with the cross-suture method with an inside-out technique. The authors hypothesized that novel repair techniques would result in less displacement after cyclic loading, increased load required to displace the repair 3 mm, greater load to failure, decreased displacement at load to failure, and increased stiffness of the repair, resulting in a construct that more closely re-creates the function of the intact meniscus. Study Design: Controlled laboratory study. Methods: A total of 36 fresh-frozen cadaveric tibial plateaus containing intact menisci were obtained. The menisci were divided into 3 groups (n = 12 in each group), and each meniscus was repaired simulating an inside-out technique. The 3 repairs completed were the hashtag, crosstag, and cross-suture techniques. Radial tears were created at the midbody of the lateral meniscus and repaired via the 3 techniques. The repaired menisci were attached to an axial loading machine and tested for cyclic and failure loading. Results: After cyclic loading, the cross-suture repair displaced 4.78 ± 1.65 mm; the hashtag, 2.42 ± 1.13 mm; and the crosstag, 3.13 ± 1.77 mm. The hashtag and cross-tag repairs both resulted in significantly less displacement ( P = .003 and .024, respectively) as compared with the cross-suture repair. The cross-suture technique had a load to failure of 81.43 ± 14.31 N; the hashtag, 86.08 ± 23.58 N; and the crosstag, 62.50 ± 12.15 N. The cross-suture and hashtag repairs both resulted in a greater load to failure when compared with the crosstag ( P = .009 and .009, respectively). There was no difference comparing the load required to displace the cross-suture technique 3 mm versus the hashtag or crosstag technique ( P = .564 and .094, respectively). However, when compared with the crosstag technique, the hashtag technique required a significantly greater load to displace the repair 3 mm ( P = .015). Conclusion: This study introduced 2 novel repair techniques—hashtag and crosstag—that did not demonstrate superiority in terms of load to failure or stiffness, but both repairs were statistically superior to the cross-suture repair in terms of displacement after cyclic loading. Considerations that may influence the validity of these techniques include cost, surgical time, and increased technical demand. Clinical Relevance: Radial tears of the meniscus are difficult to repair. Further research into more stable constructs is necessary.

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

2018 ◽  
Vol 26 (3) ◽  
pp. 230949901879951 ◽  
Author(s):  
Chih-Kai Hong ◽  
Cheng-Li Lin ◽  
Fa-Chuan Kuan ◽  
Ping-Hui Wang ◽  
Ming-Long Yeh ◽  
...  
Keyword(s):  
Cyclic Loading ◽  
Ultimate Load ◽  
Tendon Graft ◽  
Biomechanical Study ◽  
Graft Fixation ◽  
Biomechanical Property ◽  
Cross Sectional ◽  
Mode Of Failure ◽  
Load To Failure ◽  
Post Hoc

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 = 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 = 0.002 and 0.003, respectively). The stitch interval was correlated with elongation after cyclic loading ( r = 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.

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