학술논문
Biomechanical Characterization of a New Locking Loop Stitch for Graft Fixation versus Krackow Stitch.
Document Type
Academic Journal
Author
Itami Y; Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA.; Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan.; Limpisvasti O; Kerlan-Jobe Orthopaedic Clinic, Los Angeles, CA, USA.; McGarry MH; Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA.; Patel NA; Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA.; Lin CC; Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA.; Dooney T; Arthrex Inc., Naples, FL, USA.; Mihata T; Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA.; Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan.; Neo M; Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan.; Lee TQ; Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, CA, USA.
Source
Publisher: Korean Orthopaedic Association Country of Publication: Korea (South) NLM ID: 101505087 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2005-4408 (Electronic) Linking ISSN: 2005291X NLM ISO Abbreviation: Clin Orthop Surg Subsets: MEDLINE
Subject
Language
English
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.
Competing Interests: 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.
(Copyright © 2023 by The Korean Orthopaedic Association.)
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.
Competing Interests: 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.
(Copyright © 2023 by The Korean Orthopaedic Association.)