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