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. 2023 Jun;15(3):508-515.
doi: 10.4055/cios22134. Epub 2023 Mar 27.

Biomechanical Characterization of a New Locking Loop Stitch for Graft Fixation versus Krackow Stitch

Yasuo Itami  1   2 , Orr Limpisvasti  3 , Michelle H McGarry  1 , Nilay A Patel  1 , Charles C Lin  1 , Thomas Dooney  4 , Teruhisa Mihata  1   2 , Masashi Neo  2 , Thay Q Lee  1
Affiliations

Biomechanical Characterization of a New Locking Loop Stitch for Graft Fixation versus Krackow Stitch

Yasuo Itami et al. Clin Orthop Surg. 2023 Jun.

Abstract

Background: The purpose of this study was to quantify and compare the biomechanical characteristics of a new locking loop stitch (LLS), developed utilizing the concepts of both running locking stitch and needleless stitch, to the traditional Krackow stitch.

Methods: The Krackow stitch with No.2 braided suture and the LLS with 1.3-mm augmented polyblend suture tape were compared biomechanically. The LLS was performed with single strand locking loops and wrapping suture around the tendon, resulting in half the needle penetrations through the graft compared to the Krackow stitch. Twenty bovine extensor tendons were divided randomly into two groups. The tendons were prepared to match equal thickness and cross-sectional area. Each suture-tendon was stitched and preloaded to 5 N for 60 seconds, cyclically loaded to 20 N, 40 N, and 60 N for 10 cycles each, and then loaded to failure. The deformation of the suture-tendon construct, stiffness, yield load, and ultimate load were measured.

Results: The LLS had significantly less deformation of the suture-tendon construct at 100 N, 200 N, 300 N, and at ultimate load compared to the Krackow stitch (Krackow stitch and LLS at 100 N: 1.3 ± 0.1 mm and 1.0 ± 0.2 mm, p < 0.001; 200 N: 3.0 ± 0.3 mm and 1.9 ± 0.2 mm, p < 0.001; 300 N: 5.1 ± 0.6 mm and 2.9 ± 0.4 mm, p < 0.001; ultimate load: 12.8 ± 2.8 mm and 5.0 ± 1.2 mm, p < 0.001). The LLS had significantly greater stiffness (Krackow stitch and LLS: 97.5 ± 6.9 N/mm and 117.2 ± 13.9 N/mm, p < 0.001) and yield load (Krackow stitch and LLS: 66.2 ± 15.9 N and 237.9 ± 93.6 N, p < 0.001) compared to the Krackow stitch. There was no significant difference in ultimate load (Krackow stitch: 450.2 ± 49.4 N; LLS: 472.6 ± 59.8 N; p = 0.290).

Conclusions: The LLS had significantly smaller deformation of the suture-tendon construct compared to the Krackow stitch. The LLS may be a viable surgical alternative to the Krackow stitch for graft fixation when secure fixation is necessary.

Keywords: Biomechanics; Graft; Krackow; Locking loop.

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Conflict of interest statement

CONFLICT OF INTEREST: This study was partially funded by Arthrex, Inc., which provided the specimens and surgical implants for this study. The funding sources did not play any role in the design of the study or the evaluation or reporting of data.

Figures

Fig. 1
Fig. 1. Photograph showing the prepared suture-tendon constructs of the Krackow stitch (A) and locking loop stitch (B).
Fig. 2
Fig. 2. Procedure for the locking loop stitch. (A) The center of both the reinforced polyblend tape and tendon is penetrated by an initial wrapping throw to make a locking loop. (B) Slack of the locking loop is removed by hand tension (back side view). (C) The next simple wrapping suture is performed distally. (D) The wrapped suture is pinned 5 mm distal to the first throw. (E) The wrapped suture, reinforced by the polyblend tape, and tendon are penetrated together to make a second locking loop. (F) Locking loop slack is removed again (back side view).
Fig. 3
Fig. 3. Photographs of the final suture-tendon construct of the locking loop stitch. (A) Front side view. (B) Back side view.
Fig. 4
Fig. 4. Photograph of the suture-tendon construct mounted on the Instron material testing machine and knotted around the loading hook.
See this image and copyright information in PMC

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