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. 2018 Jan 31;15(1):259-263.
doi: 10.1016/j.jor.2018.01.054. eCollection 2018 Mar.

A novel method for reducing gap formation in tendon repair

Ryan Dean  1 , Paul Sethi  2
Affiliations

A novel method for reducing gap formation in tendon repair

Ryan Dean et al. J Orthop. .

Abstract

Background: This study investigates gap formation in tendon repair using a novel tensioning method.

Hypothesis: The novel stitch will demonstrate less gap formation than the other suture configurations tested.

Methods: Porcine tendons stitched with classic Krackow stitch configurations were compared to a Krackow stitch modified with a proximal Tension-Assist Loop. Each group was cyclically loaded followed by analysis of the tendon-suture construct for gap formation.

Results: The Tension-Assist Loop group produced significantly less gap formation than each of the other stitch groups.

Conclusion: Decreasing early gap formation may be beneficial in allowing early rehabilitation and range of motion.

Keywords: Biomechanical testing; Gap formation; Krackow stitch; Mechanism; Slippage; Soft tissue repair; Suture slack.

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Figures

Fig. 1
Fig. 1
This image depicts the concept of suture slack. As greater tension is applied, the foam (which represents tendon) is compressed. This results in movement of the suture with resultant gap formation. Movement is demonstrated by the black indicators advancing to the right.
Fig. 2
Fig. 2
Groups 1–4 stitch configurations (Right to Left).
Fig. 3
Fig. 3
The TAL Stitch configuration. The 15 cm loop allows for tensioning the suture from the proximal end.
Fig. 4
Fig. 4
The TAL stitch during slack-removal. The loop is above and free suture ends below. This allows for a simultaneous proximal and distal tensioning of the construct, as compared to distal hand tensioning alone.
Fig. 5
Fig. 5
After slack-reduction, the loop end of the TAL Stitch was cut and tied with 5 square knots, concluding the TAL Stitch method.
Fig. 6
Fig. 6
Torque to Force Conversion.
Fig. 7
Fig. 7
Test specimen setup. Specimen A has not undergone loading, metal crimps are adjacent to tendon end. Specimen B has undergone cyclic loading, metal crimps are no longer adjacent to tendon end, thus gap formation has occurred. Arrows indicate metal crimps.
Fig. 8
Fig. 8
Comparison of mean gap formation between each stitch group. Error bars indicate SDs. TAL: Tension Assist Loop Stitch, KFT: Krackow Stitch with FiberTape, KFW: Krackow Stich with FiberWire, KLT: Krackow Stitch with LabralTape.
See this image and copyright information in PMC

References

    1. Kearney R.S., Costa M.L. Current concepts in the rehabilitation of an acute rupture of the tendo Achilis. J Bone Joint Surg Br. 2012;94:28–31. - PubMed
    1. Maffulli N., Tallon C., Wong J. Early weightbearing and ankle mobilization after open repair of acute midsubstance tears of the Achilles tendon. Am J Sports Med. 2003;31:692–700. - PubMed
    1. Yostsumoto T., Miyamoto W., Uchio Y. Novel approach to repair of acute Achilles tendon rupture; early recovery without postoperative fixation or orthosis. Am J Sports Med. 2010;38:287–292. - PubMed
    1. Hahn J., Inceoglu S., Wongworawat M. Biomechanical comparison of krackow locking stitch versus nonlocking loop stitch with varying number of throws. Am J Sports Med. 2014;42:3003–3008. - PubMed
    1. Lee S., Goldsmith S., Nicholas S. Optimizing achilles tendon repair: effect of epitendinous suture augmentation of the strength of Achilles tendon repairs. Foot Ankle Int. 2008;29:427–432. - PubMed

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