Krackow locking stitch versus locking premanufactured loop stitch for soft-tissue fixation: a biomechanical study

Area of Science:

• Orthopedic Surgery
• Biomedical Engineering
• Sports Medicine

Background:

• Tendon repair surgeries commonly utilize suture techniques to restore tissue integrity.
• The Krackow stitch is a widely used method for securing sutures in tendon repairs.
• Alternative suture constructs are continuously being evaluated for improved biomechanical properties and clinical outcomes.

Purpose of the Study:

• To biomechanically compare construct elongation under loading conditions.
• To compare the load to failure between a locking premanufactured loop stitch and the Krackow stitch.

Main Methods:

• Twenty porcine Achilles tendons were divided into two groups: locking Krackow stitch and locking premanufactured loop stitch (SpeedWhip).
• Tendons underwent pre-tensioning, preloading to 50 N, and cyclic loading (200 cycles at 200 N).
• Construct elongation was measured at each stage, and tendons were loaded to failure.

Main Results:

• No significant difference in construct elongation was observed between the Krackow and SpeedWhip groups during initial (50 N) or cyclic loading.
• The SpeedWhip group demonstrated a significantly higher load to failure (344.0 ± 23.1 N) compared to the Krackow group (301.3 ± 24.4 N).

Conclusions:

• The locking loop stitch exhibits comparable construct elongation to the Krackow stitch in a porcine model.
• The locking loop stitch presents adequate strength and may serve as a suitable alternative to the Krackow stitch.
• Clinical use of the locking loop stitch, similar to the Krackow stitch, may necessitate postoperative augmentation or protection due to elongation characteristics.