Related Experiment Video
Updated: May 21, 2026
Using Q Suture to Enhance Resistance to Gap Formation and Tensile Strength of Repaired Flexor Tendons
Published on: June 3, 2020
Biomechanical properties of porcine flexor tendon fixation with varying throws and stitch methods
Katsunobu Sakaguchi1, Yomei Tachibana, Hiromi Oda
1Department of Orthopaedic Surgery, Saitama Medical University, 38 Morohongo, Moroyama-machi, Iruma-gun, Saitama, 350-0495, Japan. katsuguchi@msn.com
Background:
The well-known suture technique configurations used for hamstring tendon autograft preparation in anterior cruciate ligament (ACL) reconstruction are the Krackow locking stitch and nonlocking stitch, such as a baseball stitch and a whipstitch. However, there are few data in the literature regarding biomechanical comparisons of suture techniques.
Purpose:
The purpose of this study was to determine the properties of several current techniques of tendon graft suture employed in ACL reconstruction.
Study Design:
Controlled laboratory study.
Methods:
Forty-two fresh-frozen porcine flexor digitorum tendons were used. Three stitch configurations (Krackow stitch [group K], baseball stitch [group B], and whipstitch [group W]) were assessed with varying suture throws (6 throws, group×6; 10 throws, group×10) using No. 5 Ethibond sutures. Each group was tested at 1500 loading cycles between 50 and 200 N. After loading cycles, the surviving tendons underwent a load-to-failure test.
Results:
During the loading cycles, 3 of 7 specimens in group B×6 and all specimens in group W×6 failed by suture pullout. Four of 7 specimens in group B×10 and all specimens in group W×10 showed partial tearing of the tendon. Elongation of group B×10 and group W×10 showed significantly greater elongation than other groups (P < .05). Maximum loads at failure showed significant differences between group K and the other groups (K×6, 436 ± 52 N; K×10, 419 ± 34 N; P < .05). Most specimens failed by rupture of the suture thread in group K. Pullout of the suture from the tendon was observed most in groups B and W.
Conclusion:
The Krackow stitch was superior to other stitch methods. There was, however, no significant effect of the number of throws on the holding strength.
Clinical Relevance:
The Krackow stitch could prevent suture slippage by a locking mechanism. The whipstitch is not suitable for clinical application even with an increased number of throws.
