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Updated: Apr 16, 2026
A Novel Tenorrhaphy Suture Technique with Tissue Engineered Collagen Graft to Repair Large Tendon Defects
Published on: December 10, 2021
Evaluation of 3 Needleless Grasping Suture Techniques for Soft-Tissue Graft Fixation: A Porcine Biomechanical Study
Chih-Kai Hong1, Ming-Long Yeh2, I-Ming Jou3
1Department of Medicine, National Cheng Kung University College of Medicine, Tainan, Taiwan.
Purpose:
The purpose of this study was to evaluate the tendon graft holding strength of 3 needleless grasping suture techniques, namely the modified Prusik knot, Wittstein suture loop, and modified rolling hitch.
Methods:
Thirty fresh-frozen porcine flexor profundus tendons were used and randomly divided into 3 groups of 10 specimens. The experimental procedure was designed to assess elongation of the suture-tendon construct across 3 different needleless tendon-grasping techniques. All suture configurations were completed with a multistranded nonabsorbable suture. Each tendon was pre-tensioned to 100 N for 3 cycles, cyclically loaded to 200 N for 200 cycles, and then finally loaded to failure. Elongation, load to failure, and mode of failure for each suture-tendon construct were measured.
Results:
During cyclic loading, there were no significant differences in elongation for any of the tested suture-tendon constructs (modified rolling hitch, 21.2% ± 9.6%; modified Prusik knot, 21.4% ± 9.9%; and Wittstein suture loop, 26.2% ± 4.5%). Similarly, the failure load and cross-sectional area were not significantly different across all tested suture groups.
Conclusions:
The modified Prusik knot, Wittstein suture loop, and modified rolling-hitch techniques had equal elongation after cyclic loading, as well as load to failure, in this in vitro biomechanical evaluation.
Clinical Relevance:
These needleless grasping suture techniques may be an attractive alternative to the commonly used whipstitch techniques for tendon graft fixation in ligament reconstruction.
