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DOI: 10.1055/s-0038-1633041
In Vitro Comparison of the Krackow and Locking Loop Suture Patterns for Tenorrhaphy of Flat Tendons
Publication History
Received for publication
02 August 1993
Publication Date:
06 February 2018 (online)
Summary
Tenorrhaphy of 20 pairs of canine patellar tendons, was by a modification of the Krackow suture pattern on one of the pair and a single locking loop suture pattern on the contralateral tendon. The tenorrhaphies were pulled apart at a rate of 127 cm/min. The mode of failure for all tendons was disruption of the tendon and the suture material pulling out of the tendon. The mean maximum load for the locking loop suture pattern was 67.2 N (S.D. 7.8), compared to 61.3 N (S.D. 9.3) for the modified Krackow suture pattern. The mean energy absorbed to maximum load was 0.54 Joules (J) (S.D. 0.168) for the locking loop and 0.37 J (S.D. 0.12) for the modified Krackow. The mean stiffness was 4846 N/m (S.D. 803) for the locking loop and 5573 N/m (S.D. 921) for the modified Krackow.
This study indicated the locking loop suture pattern was significantly better than the modified Krackow suture pattern in maximum strength (p = 0.03), total energy absorbed to failure (p = 0.0004) and stiffness (p = 0.004). Both suture patterns are suitable for use in flat tendons or ligaments based on their maximum strength. However, the effect of the modified Krackow suture pattern on vascularity and healing has not been evaluated.
The locking loop suture pattern proved to be significantly better than the modified Krackow suture pattern in maximum strength, total energy absorbed to failure and stiffness.
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References
- 1 Krackow KA, Thomas SC, Jones LC. A new stitch for ligament-tendon fixation. J Bone Joint Surg 1986; 68A: 764-5.
- 2 Knecht CD, Allen AR, Williams DJ, Johnson JH. Fundamental Techniques in Veterinary Surgery. 2nd ed. Philadelphia: Saunders; 1981: 57.
- 3 Ketchum LD, Martin NL, Kappel OA. Experimental evaluation of factors affecting the strength of tendon repairs. Plast Reconstr Surg 1977; 59: 708-19.
- 4 Urbaniac JR, Cohill JD, Mortenson RA. Tendon suturing methods: analysis of tensile strengths. In: AAOS Symposium on Tendon Surgery in the Hand. St. Louis: CV Mosby Co.; 1975: 70-80.
- 5 Peacock EE. Wound Repair. 3rd Ed. Philadelphia: Saunders; 1984: 263-331.
- 6 Pennington DG. The locking loop tendon suture. Plast Reconstr Surg 1979; 63: 648-52.
- 7 Stein LE, Pijanowski GJ, Johnson AL. A histological evaluation of rabbit tendons sutured using the Bunnell pattern. Vet Surg 1985; 14: 145-8.
- 8 Tomlinson J, Moore R. Locking loop suture use in repair of five calcanean tendons. Vet Surg 1982; 11: 105-9.
- 9 Berg RJ, Egger EL. In vitro comparison of the three loop pulley and locking loop suture patterns for repair of canine weightbearing tendons and collateral ligaments. Vet Surg 1986; 15: 107-10.
- 10 Pijanowski GJ, Stein LE, Turner TA. Strength characteristics and failure modes of suture patterns in severed goat tendons. Vet Surg 1989; 18: 335-9.
- 11 Jann HW, Stein LE, Good JK. Strength characteristics and failure modes of locking-loop and three-loop pulley suture patterns in equine ten-dons. Vet Surg 1990; 19: 28-33.
- 12 Easley KJ, Stashak TS, Smith FW, Van Slyke G. Mechanical properties of four suture patterns for transected equine tendon repair. Vet Surg 1990; 19: 102-6.
- 13 Bertone AL, Stashak TS, Smith FW, Norrdin RW. A comparison of repair methods for gap healing in equine flexor tendon. Vet Surg 1990; 19: 254-65.
- 14 Chick LR, Walton RL. A history of tendon operations. Surg Gynecol Obstet 1989; 168: 183-8.
- 15 Early TD. Tendon disorders. In: Pathophysiology in Small Animal Surgery. Bojarab MJ. (ed). Philadelphia: Lea and Febiger; 1981: 851-66.
- 16 Braden TD. Tendons and muscles. In: Current Techniques in Small Animal Surgery. Bojarab MJ. (ed). Philadelphia: Lea and Febiger; 1975: 343-55.
- 17 Graf BK, Fujisaki K, Vanderby R, Vailas AC. The effects of in situ freezing on rabbit patellar tendon. Am J Sports Med 1992; 20: 401-5.
- 18 Haut RC, Lancaster RL, DeCamp CE. Mechanical properties of the canine patellar tendon: some correlations with age and the content of collagen. J Biomechanics 1992; 25: 163-73.
- 19 Elliott DH. The biomechanical properties of tendon in relation to muscular strength. Ann Phys Med 1967; 9: 1-7.
- 20 Hirsch G. Tensile properties during tendon healing. Acta Orthop Scand 1974; [Suppl]: 153.
- 21 Walker LB, Harris EH, Benedict JV. Stress-strain relationship in human cadaveric plantaris tendon. Med Electron Biol Eng 1964; 2: 31-8.
- 22 Dueland R, Quenin J. Triceps tenotomy: Biomechanical assessment of healing strength. J Am Hosp Assoc 1980; 16: 507-12.
- 23 Frank C, Schachar N, Ditrich D. Natural history of healing in the repaired medial collateral ligament. J Orthop Res 1983; 1: 179-88.
- 24 Montgomery RD. Healing of muscle, ligaments and tendons. Semin Vet Med Surg 1989; 4: 304-11.
- 25 Gelberman RH, Menon J, Gonsalves M. et al. The effect of mobilization on the vascularization of healing flexor tendons in dogs. Clin Orthop 1980; 153: 283-9.
- 26 Woo SL, Masahiro I, McGurk-Burleson E. et al. Treatment of the medial collateral ligament injury. Am J Sports Med 1987; 15: 22-9.
- 27 Woo SL, Gomez MA, Inoue M. et al. New experimental procedures to evaluate the biomechanical properties of healing canine medial collateral ligaments. J Orthop Res Soc 1987; 5: 425-32.
- 28 Gelberman R, Vande Berg J, Manski P, Akeson W. The early stages of flexor tendon healing. Trans Orthop Res Soc 1985; 10: 13.
- 29 Chaplin DM. The vascular anatomy within normal tendons, divided tendons, free grafts and pedicle tendon grafts in rabbits. J Bone Joint Surg 1973; 55B: 369-89.
- 30 Nystrom B, Holmlund D. Experimental evaluation of immobilization in operative and non-operative treatment of Achilles tendon rupture. Acta Chir Scand 1983; 149: 669-73.