Purpose
To compare the biomechanical properties of high-tensile strength tape and high-tensile
strength suture across 2 selected stitch techniques, the Krackow and whip stitch,
in securing tendinous tissue during 5,000 cycles of nondestructive loading followed
by a load to failure.
Methods
Fourteen matched pairs each of cadaveric Achilles, quadriceps, and patellar tendons
(n = 84) were randomly assigned to either Krackow or whip stitch and sutured with
either 2-mm high-tensile strength tape or No. 2 high-tensile strength suture. Specimens
were preloaded to 20 N, cyclically loaded from 20 to 200 N for 5,000 cycles at 2 Hz,
and then loaded to failure at 200 mm/min. Linear mixed models evaluated the effects
of suture material and stitch technique on cyclic normalized tendon−suture elongation,
total normalized tendon-suture elongation at 5,000 cycles, and maximum load at failure.
Results
Across all suture constructs, normalized elongation was greater during the initial
10 cycles, compared with all subsequent cycling intervals (all P < .001). There was less total normalized elongation (β = −0.239; P = .007) and greater maximum load at failure in tape (β = 163.71; P = .014) when used in the Krackow stitch compared with the whip stitch.
Conclusions
Our findings indicate that tape used in the Krackow stitch maintains the most favorable
fixation strength after enduring cyclic loading, with greater maximum load at failure.
In addition, overall normalized elongation during long-term cyclic loading was predominately
affected by the stitch technique used, regardless of the suture material; however,
tape allowed less normalized elongation during the initial loading cycles, especially
when placed in the whip stitch.
Clinical Relevance
Understanding the potential short- and long-term outcomes of suture material and stitch
technique on securing tendinous tissue under repetitive stresses can help inform clinicians
on optimal tendon fixation techniques for early postoperative activities.
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References
- Epidemiology of Achilles tendon ruptures: Increasing incidence over a 33-year period.Scand J Med Sci Sports. 2015; 25: e133-e138
- Acute Achilles tendon ruptures: Incidence of injury and surgery in Sweden between 2001 and 2012.Am J Sports Med. 2014; 42: 2419-2423
- The role of recreational sport activity in Achilles tendon rupture: A clinical, pathoanatomical, and sociological study of 292 cases.Am J Sports Med. 1989; 17: 338-343
- Epidemiology of Achilles tendon ruptures in the United States: Athletic and nonathletic injuries from 2012 to 2016.Orthop J Sports Med. 2018; 6 (2325967118808238)
- Incidence of major tendon ruptures and anterior cruciate ligament tears in US Army soldiers.Am J Sports Med. 2007; 35: 1308-1314
- Acute Achilles tendon rupture: Minimally invasive surgery versus nonoperative treatment with immediate full weightbearing—a randomized controlled trial.Am J Sports Med. 2008; 36: 1688-1694
- Quadriceps and patellar tendon rupture.Injury. 2006; 37: 516-519
- Operative versus nonoperative treatment of acute Achilles tendon rupture: An analysis of 12,570 patients in a large healthcare database.Foot Ankle Surg. 2015; 21: 250-253
- Cyclic loading of 3 Achilles tendon repairs simulating early postoperative forces.Am J Sports Med. 2009; 37: 786-790
- Biomechanical comparison of 3 methods to repair pectoralis major ruptures.Am J Sports Med. 2012; 40: 1635-1640
- Biomechanical comparison of Krackow locking stitch versus nonlocking loop stitch with varying number of throws.Am J Sports Med. 2014; 42: 3003-3008
- A biomechanical comparison of the pullout strength of No. 2 FiberWire suture and 2-mm FiberWire tape in bovine rotator cuff tendons.Arthroscopy. 2010; 26: 1463-1468
- Tape versus suture in arthroscopic rotator cuff repair: biomechanical analysis and assessment of failure rates at 6 months.Orthop J Sports Med. 2017; 5 (2325967117701212)
- Independent suture tape reinforcement of small and standard diameter grafts for anterior cruciate ligament reconstruction: A biomechanical full construct model.Arthroscopy. 2018; 34: 490-499
- Anterior cruciate ligament reconstruction with suture tape augmentation.Arthrosc Tech. 2018; 7: e385-e389
- Posteromedial ligament repair of the knee with suture tape augmentation: A biomechanical study.Am J Sports Med. 2019; 47: 2952-2959
- Biomechanical evaluation of arthroscopic rotator cuff stitches.J Bone Joint Surg. 2004; 86: 1211-1216
- High-tensile strength tape versus high-tensile strength suture: A biomechanical study.Arthroscopy. 2016; 32: 356-363
- Musculoskeletal disorders and the workplace: Low back and upper extremities.National Academy Press, Washington, DC2001
- Quadriceps tendon rupture.J Am Acad Orthop Surg. 2003; 11: 192-200
- Gap formation in transpatellar patellar tendon repair: Pretensioning Krackow sutures versus standard repair in a cadaver model.Am J Sports Med. 2010; 38: 171-175
- Pectoralis major muscle rupture repair: Technique using unicortical buttons.Arthrosc Tech. 2012; 1: e119-e125
- Does suture technique affect re-rupture in arthroscopic rotator cuff repair? A meta-analysis.Arthroscopy. 2015; 31: 1576-1582
- Cyclic loading of posterior cruciate ligament replacements fixed with tibial tunnel and tibial inlay methods.J Bone Joint Surg. 2002; 84: 518-524
- Cyclic loading of Achilles tendon repairs: A comparison of polyester and polyblend suture.Foot Ankle Int. 2006; 27: 512-518
- Achilles tendon repair: Achillon system vs. Krackow suture: An anatomic in vitro biomechanical study.Clin Biomech. 2008; 23: 1158-1164
- The effect of cyclic loading on rotated bone-tendon-bone anterior cruciate ligament graft constructs.Am J Sports Med. 2006; 34: 1442-1449
- Biomechanical properties of suture anchor repair compared with transosseous sutures in patellar tendon ruptures: A cadaveric study.Am J Sports Med. 2013; 41: 2540-2544
- Multiple regression approach to analyzing contingency tables: Post hoc and planned comparison procedures.J Exp Educ. 1995; 64: 79-93
- Fitting linear mixed-effects models using lme4.J Stat Softw. 2015; 67: 1-48
- Novel augmentation technique for patellar tendon repair improves strength and decreases gap formation: A cadaveric study.Clin Orthop Relat Res. 2016; 474: 2611-2618
- Biomechanical properties of quadruple tendon and patellar tendon femoral fixation techniques.Knee Surg Sports Traumatol Arthrosc. 2001; 9: 337-342
- Biomechanical comparison of patellar tendon repairs in a cadaver model: An evaluation of gap formation at the repair site with cyclic loading.Am J Sports Med. 2002; 30: 469-473
- Tensile and viscoelastic properties of human patellar tendon.J Orthop Res. 1994; 12: 796-803
- Early functional rehabilitation versus traditional immobilization for surgical Achilles tendon repair after acute rupture: A systematic review of overlapping meta-analyses.Sci Rep. 2017; 7: 1-7
- A biomechanical comparison of six suture configurations for soft tissue–based graft traction and fixation.Arthroscopy. 2019; 35: 1163-1169
- Soft tissue fixation strategies of human quadriceps tendon grafts: A biomechanical study.Arthroscopy. 2019; 35: 3069-3076
- Biomechanical properties of porcine flexor tendon fixation with varying throws and stitch methods.Am J Sports Med. 2012; 40: 1641-1645
- The use of suture anchors in repair of the ruptured patellar tendon: A biomechanical study.Am J Sports Med. 2006; 34: 1492-1499
- Quadriceps tendon graft for anterior cruciate ligament reconstruction: The graft of the future!.Arthroscopy. 2019; 35: 696-697
Article Info
Publication History
Published online: April 22, 2021
Accepted:
April 14,
2021
Received:
January 19,
2021
Footnotes
See commentary on page 2934
The authors report the following potential conflicts of interest or sources of funding: This research was supported in part by an appointment to the Department of Defense (DoD) Research Participation Program administered by the Oak Ridge Institute for Science and Education (ORISE) through an interagency agreement between the U.S. Department of Energy (DoE) and the DoD. ORISE is managed by ORAU under DoE contract number DE-SC0014664. Additionally, funding was provided for portions of this project through the Walter Reed National Military Medical Center Department of Research Programs Graduate Medical Education Research funds (PI: W.B.R.). The views expressed in this paper are those of the authors and do not reflect the official policy of the DoE, ORAU/ RISE Department of the Army/Navy/Air Force, Uniformed Services University of the Health Sciences, DoD, or U.S. Government. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2021 by the Arthroscopy Association of North America. Published by Elsevier. All rights reserved.
