J Foot Ankle Surg. Quantitative comparison of three rat models of Achilles tendon injury: A multidisciplinary approach. Comparison of the double loop knot stitch and Kessler stitch for Achilles tendon repair: A biomechanical cadaver study. The Krackow suture presented with superior resistance, with a rupture rate 16.70% but with a mean elongation of 7.11 mm. BACKGROUND: The Krackow technique has the advantage of high strength, though it is not minimally invasive. Our technique uses a nonabsorbable suture loop (Fiberloop; Arthrex, Naples, FL). 2019 May 9;88:194-200. doi: 10.1016/j.jbiomech.2019.03.029. Background: 2017 Dec;50:78-83. doi: 10.1016/j.clinbiomech.2017.10.008. Epub 2019 Mar 27. la Fuente C, Cruz-Montecinos C, Schimidt HL, Henríquez H, Ruidiaz S, Carpes FP. Bunnell vs. Krackow sutures. Results: Porém, pela utilização de um maior número de fios a vascularização tecidual fica comprometida. In 1986, Krackow et al.2 published the description of a new locking suture for fixating ligaments, tendons, or cap-sular components to bone. Am J Sports Med. 2019 Jan;52(1):109-116. doi: 10.1055/s-0039-1687923. J Biomech. Our hypothesis was that the strength of different repair techniques would be comparable if a similar number of suture strands cross the repair site. Biomechanical evaluation of patellar tendon repair using Krackow suture technique . 2 This has been attributed to using multiple suture strands across the tear site and tying notes away from the repair. Statistical analysis was performed using the χ2 test and analysis of variance, with the 95% confidence intervals (p < .05). Epub 2019 May 2. Kessler vs. Krackow sutures Copyright © 2017 American College of Foot and Ankle Surgeons. Conclusion: Epub 2015 Jun 10. Unable to load your collection due to an error, Unable to load your delegates due to an error. We simulated a rupture by performing resection in the middle portion of the tendon, 4 cm proximal to the calcaneus insertion. Biomechanical comparison of the primary stability of suturing Achilles tendon rupture: a cadaver study of Bunnell and Kessler techniques under cyclic loading conditions. Biomechanical properties of different techniques used in vitro for suturing mid-substance Achilles tendon ruptures. MATERIAL and METHODS . The needle is passed through the tendon end and out the tendon end closest to the marginal edge in acceptable tissue. Clanton TO, Haytmanek CT, Williams BT, Civitarese DM, Turnbull TL, Massey MB, Wijdicks CA, LaPrade RF. Causes of re-rupture have been reportedly due to traumatic episodes, patient non … The fairly high sample sizes for these three groups suggest robust data, but we still assessed subgroups by suture type. Keywords: Does elasticity of Achilles tendon change after suture applications? 8600 Rockville Pike pulley, Krackow, and double Bunnell‐Mayer suture patterns ... that use of a knotless barbed suture technique was biome-chanically inferior to a 4‐strand modified Kessler technique in a chicken model. A previous study suggests the double Krackow suture (locking-loop) weave technique is nearly twice as strong as the single Bunnell or single Kessler suture repair techniques. The classic Krackow stitch involves 3 or more locking loops placed along each side of the ligament or tendon. Core weave versus Krackow technique for Achilles tendon repair: a biomechanical study. Thirty-six healthy male White New Zealand rabbits 12 to 18 months old, 2.5 to 3.1 kg in body weight were used in the study. 34 Regardless of repair technique, suture Therefore, according to our findings and the published data, we recommend double Bunnell sutures for the surgical treatment of acute Achilles tendon rupture. We used absorbable suture (polydioxanone no. 1) with all the techniques. Epub 2012 Mar 31. BACKGROUND: A previous study suggests the double Krackow suture (locking-loop) weave technique is nearly twice as strong as the single Bunnell or single Kessler suture repair techniques. Herbort M, Haber A, Zantop T, Gosheger G, Rosslenbroich S, Raschke MJ, Petersen W. Arch Orthop Trauma Surg. This site needs JavaScript to work properly. Accessibility Double Krackow, double Bunnell and double Kessler ... FHL with non-absorbable suture. The Krackow Suture, by Dr. Kenneth Krackow, 2008. Sadoghi P, Rosso C, Valderrabano V, Leithner A, Vavken P. Int Orthop. Our hypothesis was that the strength of different repair techniques would be comparable if a similar number of suture strands cross the repair site. Frosch S, Buchhorn G, Hawellek T, Walde TA, Lehmann W, Hubert J. PLoS One. FOIA Achilles tendon; acute tendon rupture; cadaveric study; suture techniques. We performed an experimental anatomic study with 27 fresh-frozen human cadaveric Achilles tendons obtained through the body donation program of the University of Barcelona, testing the maximum strength. ... AT receives blood supply from FHL. Assessment of the Resistance of Several Suture Techniques in Human Cadaver Achilles Tendons. Insert two Krackow stitches of #5 non-absorbable suture into the patellar tendon, as illustrated. In 1986, Krackow et al. pair is often indicated, the ideal suture technique remains unclear [1–6]. Careers. For direct end-to-end repair we saw the highest tensile strength for the Bunnell technique, and somewhat lower values for Krackow and Kessler techniques, although the latter two produced widely equivalent results. Sadoghi P, Rosso C, Valderrabano V, Leithner A, Vavken P. Int Orthop. Although there were reported reruptures after a Bunnell suture, we consider this method and used a modified Bunnell one in the majority of our patients with direct primary sutures. 2020 Dec 3;15(12):e0243306. Epub 2017 Oct 9. However, primary repair of ruptured Achilles tendons has resulted in partial or complete re-ruptures in over 5% of patients [2, 14, 15]. Unable to load your collection due to an error, Unable to load your delegates due to an error. Epub 2012 Mar 31. Tendons were loaded with continuous tension at a head speed of 0.85 cm/s. In this study, the ultimate tensile load eCollection 2020. Efficacy of repair techniques of the Achilles tendon: A meta-analysis of human cadaveric biomechanical studies. 2012 Sep;36(9):1947-51. doi: 10.1007/s00264-012-1533-6. Clipboard, Search History, and several other advanced features are temporarily unavailable. The Krackow locking loop technique has been favoured for open repair since a biomechanical study using cadaveric Achilles tendons revealed that the initial strength of the Krackow suture was substantially higher than that of the Kessler and Bunnell sutures [6, 20]. Please enable it to take advantage of the complete set of features! BACKGROUND: A previous study suggests the double Krackow suture (locking-loop) weave technique is nearly twice as strong as the single Bunnell or single Kessler suture repair techniques. The “Locking Block Modified Krackow” (LBMK) peri-tendon fixation technique was designed for minimally invasive surgery. 2017 Mar;30:13-20. doi: 10.1016/j.foot.2016.09.006. In this study, we investigated how the two- and four-stranded Krackow suture weave techniques compared with a novel Krackow/Bunnell suture technique. We then evaluated the double Kessler, double Bunnell, Krackow, and percutaneous Ma and Griffith technique. Privacy, Help This modified Bunnell is a preference of the main author (IS). Recent studies have shown that double stitches are superior to simple sutures. This is repeated in the second suture strand where it is started Two studies , with a total of 27 ankles compared Bunnell and Krackow sutures via open technique. Many treatments are available for acute Achilles tendon ruptures, conservative and surgical, with none superior to another. Would you like email updates of new search results? The tendons were fixed on a testing machine and loaded until failure. The tendons were then anchored to a materials testing machine (Instron, Canton, MA) through a calcaneal pin distally and a modified soft tissue clamp proximally. Make holes in the main fragment Careers. Clipboard, Search History, and several other advanced features are temporarily unavailable. Foot (Edinb). Clin Biomech (Bristol, Avon). Prevention and treatment information (HHS). Materials and methods: The "Locking Block Modified Krackow" (LBMK) peri-tendon fixation technique was designed for minimally invasive surgery. The Krackow and Bunnell suture were superior in endurance, strength of failure, and primary stability compared with the other suture types. The suturing configuration can vary depending on the surgeon's preference. The Krackow technique has the advantage of high strength, though it is not minimally invasive. Evaluation of repair area by acoustic radiation force impulse elastography. Periasamy M, Venkatramani H, Shanmuganathan RS. Traction was performed using a machine that pulls the tendon at 10 to 100 N in 1000 repetitive cycles. Indian J Plast Surg. The Krackow whip stitch is stronger than the Kessler, or Bunnell, stitches that are used for repairing smaller tendons. The Krackow suture presented with superior resistance, with a rupture rate 16.70% but with a mean elongation of 7.11 mm. FOIA 2010 Aug;31(8):701-5. doi: 10.3113/FAI.2010.0701. 3.3.4. Epub 2008 Feb 29. 2018 Mar 2;13(1):45. doi: 10.1186/s13018-018-0751-z. The giftbox method has been shown to have a >2-fold increase in the suture pullout strength. We then evaluated the double Kessler, double Bunnell, Krackow, and percutaneous Ma and Griffith technique. Epub 2017 Jan 28. The most frequently described techniques are the Bunnell [7], Kessler [8], and Krackow sutures [9]. This study aimed to compare the biomechanics of LBMK with Kessler and Percutaneous Achilles Repair System (PARS) techniques using a simulated early rehabilitation program. Initial Achilles tendon repair strength--synthesized biomechanical data from 196 cadaver repairs. All repairs failed at the site of the suture knots, none pulling out through the substance of the tendon. A Biomechanical Comparison of an Open Repair and 3 Minimally Invasive Percutaneous Achilles Tendon Repair Techniques During a Simulated, Progressive Rehabilitation Protocol. Foot Ankle Int. The goal of this setup was to obtain a natural rupture pattern. 8600 Rockville Pike Learn how to perform the Krackow suture with materials everybody has at home! FHL AUGMENTED REPAIR Newer technique to improve surgical treatment of chronic AT rupture of Kuwada stage 4 No statistically significant difference was noted between the double Krackow weave (199.9 +/- 20 N), the double Bunnell weave (196.2 +/- 45 N), and the double Kessler weave (166.9 +/- 51 N). The most frequently described techniques are the Bunnell , Kessler , and Krackow sutures . Epub 2017 Jan 28. Efficacy of repair techniques of the Achilles tendon: A meta-analysis of human cadaveric biomechanical studies. Open the patellar tendon retinaculum longitudinally. The simulated ruptures were created in the midsubstance of the Achilles tendon, five centimeters proximal to its calcaneal insertion. Bethesda, MD 20894, Copyright The aim of this study was to compare the Kessler stitch and double loop knot stitch (DLKS) in a cyclic loading … Krackow.14 The triple-bundle technique is touted as the strongest in biomechanical studies, but there are clinical concerns regarding disruption of the vascularity of the tendon due to large amounts of suture employed.11,14 Finally, repairs using the Bunnell stitch have exhibited the greatest tensile strength of the commonly used techniques, outperforming the Kessler and Krackow by a significant margin.22 Krackow suture technique. None proved to be better (0.80, 95% CI = 1.657–0.045, I 2 = 87.6%, P = 0.06). Karatekin YS, Karaismailoglu B, Kaynak G, Ogut T, Dikici AS, Ure Esmerer E, Aydingoz O, Botanlioglu H. J Orthop Surg Res. 2017 Mar;30:13-20. doi: 10.1016/j.foot.2016.09.006. A one-way analysis of variance was performed on the maximum force at failure of each repair technique. Published by Elsevier Inc. All rights reserved. All repairs failed at the site of the suture knots, with none pulling out through the substance of the tendon. We used absorbable suture (polydioxanone no. Initial Achilles tendon repair strength--synthesized biomechanical data from 196 cadaver repairs. All suture failed and no pull out in the tendon was reported for both type of sutures. age strength of tendon fixation from the Krackow technique (147 newtons) proved significantly stronger than the Kessler modification technique (85 newtons) and the Bunnel tech-nique (93 newtons)(15). 1) with all the techniques. Hong Y, Hermida L, White KL, Parks BG, Camire LM, Guyton C. Foot Ankle Int. Accessibility 2008 Nov;128(11):1273-7. doi: 10.1007/s00402-008-0602-1. We found no significant differences among the different open suture techniques (p > .05). Would you like email updates of new search results? There are a variety of suture techniques described for grasping and holding soft tissues. Cyclic loading conditions represent the repetitive loading in rehabilitation. 2015 Aug;43(8):1957-64. doi: 10.1177/0363546515587082. Open the patellar tendon retinaculum longitudinally. Regardless of the technique selected, the repaired tendon must be able to provide appropriate strength to resist loading during postoperative mobilization caused by physical therapy. Tendon elongation after Achilles tendon (AT) repair is associated with the clinical outcome. The double Bunnell suture had the same rupture rate as the Krakow suture (16.70%) but with an inferior mean elongation of 4.53 mm. Foot (Edinb). 2010 Dec;31(12):1107-10. doi: 10.3113/FAI.2010.1107. Thanks for the music, Richie! The attenuation may be explained by both suture pull-out from the tendon repair construct (due to tightening of the loop and/or tearing of tendon fiber) and the amount of tendon and suture incorporated into each repair [4,5]. For surgical treatment, one can use various techniques. Bethesda, MD 20894, Copyright (8,12-14) Estudos prévios demonstraram que a sutura do tipo Krackow é a mais resistente comparativamente à técnica de Kessler. 9 0 0 Twenty-four fresh-frozen human cadaver Achilles tendons were used to test maximum strength of three suture techniques (double Bunnell, double Kessler, and double Krackow). Clinical relevance: We found that in a laboratory model of cadaveric Achilles tendon repairs there was no significant difference in strength between the Krackow, Bunnell, and Kessler suture techniques, when each was performed with a double suture weave. 2 polyester (Mersilene, Ethicon, Sommerville, NJ) nonabsorbable suture in standard fashion for each technique, with four strands crossing the repair site. 2017 Sep-Oct;56(5):954-959. doi: 10.1053/j.jfas.2017.06.018. The use of bidirectional barbed suture in the treatment of a complete common calcanean tendon rupture in a dog: Long-term clinical and ultrasonographic evaluation. The Krackow whip stitch is stronger than the Kessler, or Bunnell, stitches that are used for repairing smaller tendons. The most usual techniques for primary open repair are Bunnel, Kessler and Krackow sutures (6, 19). Several variations of this technique have been developed. 2012 Sep;36(9):1947-51. doi: 10.1007/s00264-012-1533-6. Our hypothesis was that the Krackow/Bunnell suture would have greater strength compared with the two- and four-stranded Krackow suture in terms of resistance to pullout from the muscle tendon. The double Bunnell suture had the same rupture rate as the Krakow suture (16.70%) but with an inferior mean elongation of 4.53 mm. neo e, dentre elas, destacam-se: Krackow, Kessler, Bunnell, suturas triplas e técnica de Krackow modificada. This site needs JavaScript to work properly. Manent A, Lopez L, Vilanova J, Mota T, Alvarez J, Santamaría A, Oliva XM. staggered fashion using 3 suture strands for each tendon end, with the first suture strand started on the most peripheral edge of the tendon and looped-locked approximated 1 cm from the rupture site. During maximal traction testing, this technique presented tendon failure, whereas the Krackow, Double-Kessler, and Double-Dresden techniques had suture failures. Reliable suture techniques are essential to reduce gap formations and to allow early mobilization. Privacy, Help Ten pairs of fresh frozen Achilles tendons were obtained from human donors (41-85 years). Prevention and treatment information (HHS). Therefore, in the present study, we sought to determine the suture technique that is the most resistant to rupture. Please enable it to take advantage of the complete set of features! However, there was no significant difference in suture strength between the Krackow, Bunnell, and Kessler techniques that were performed with a double All repairs were performed with No. However, the former presented with greater tendon elongation, although the difference was not statistically significant. The Krackow and Bunnell suture were superior in endurance, strength of failure, and primary stability compared with the other suture types. National Library of Medicine Primary suture repair is the current standard of care, and many different suture techniques are available (e.g., Krackow, Bunnell, Kessler, three-loop pulley, epitendinous suture augmentation) [8-13]. Management of Chronic Achilles Tendon Injuries-Review of Current Protocols and Surgical Options. National Library of Medicine The strength of achilles tendon repair: a comparison of three suture techniques in human cadaver tendons. Frame K, Ben-Amotz O, Simpler R, Zuckerman J, Ben-Amotz R. Clin Case Rep. 2019 Jul 10;7(8):1565-1572. doi: 10.1002/ccr3.2287. Traction was performed using a machine that pulls the tendon at 10 to 100 N in 1000 repetitive cycles. Regardless of the technique selected, the repaired tendon must be able to provide appropriate strength to resist load-ing during postoperative mobilization caused by physical This study aimed to compare the biomechanics of LBMK with Kessler and Percutaneous Achilles Repair System (PARS) techniques using a simulated early rehabilitation program. The “Giftbox” Repair of the Achilles Tendon: a Modification of the Krackow Technique, 2009. Comparison of Double Bunnell, Double Kessler and Double Krackow Suture Techniques, 2010. Background: A previous study suggests the double Krackow suture (locking-loop) weave technique is nearly twice as strong as the single Bunnell or single Kessler suture repair techniques. Great article from Solvenia, Achilles Tendon Repair Under Local Anesthesia, 2011 At the present study, common used suture techniques consist of Modified Kessler, Krackow, Bunnel were compared with the newly described technique using histological, biomechanical parameters. eCollection 2019 Aug. Huegel J, Boorman-Padgett JF, Nuss CA, Minnig MCC, Chan PY, Kuntz AF, Waldorff EI, Zhang N, Ryaby JT, Soslowsky LJ. doi: 10.1371/journal.pone.0243306. The ruptured tendons were sutured either with BB MonoMax or PDS and again loaded u… the joints. Our hypothesis was that the strength of different repair techniques would be comparable if a similar number of suture strands cross the repair site. FHL AUGMENTED REPAIR. This is a cadaveric study that attempts to simulate the clinical parameters of Achilles tendon ruptures, repairs, and repair failures to examine the strength of different repair techniques.
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