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Updated: May 7, 2026
A Novel Tenorrhaphy Suture Technique with Tissue Engineered Collagen Graft to Repair Large Tendon Defects
Published on: December 10, 2021
Biomechanical comparison of tendon graft suturing techniques in arthroscopic ligament reconstruction using a novel
Killi Madhu Babu1, T Gipson Samuel2, Anirudh Dwajan3
1Department of Orthopaedics, PGI-Chandigarh, Chandigarh, India.
Background:
Secure tendon-suture constructs are essential for tendon harvesting, graft passage, and controlled tensioning during ligament reconstruction and tendon procedures. The Krackow stitch is commonly used but involves multiple needle passes and may be associated with tendon damage and needle-stick injury. Although needleless techniques have been described, biomechanical evidence based on fresh human cadaver tendons remains limited. This study aimed to evaluate the biomechanical performance of a novel knotless double-loop tendon suture technique (DLKT) and compare it with the standard Krackow stitch and a needleless modified finger-trap technique (MFTT).
Methods:
This experimental biomechanical study used fresh human cadaver tendons harvested within 24 h of death. Semitendinosus, gracilis, and peroneus longus tendons were prepared and assigned to three groups based on the suture technique: Krackow, MFTT, or DLKT. All tendon-suture constructs were subjected to axial loading until failure using a universal testing machine. The primary outcome was ultimate load to failure (N), and the secondary outcome was the mechanism of failure. Statistical analysis included one-way analysis of variance with post-hoc testing and chi-square analysis.
Results:
A total of 150 tendon-suture constructs were analyzed. The mean ultimate load to failure of the DLKT was comparable to that of the Krackow stitch and significantly higher than that of the MFTT. Similar trends were observed across semitendinosus, gracilis, and peroneus longus tendons. Suture cut-out was the most common failure mode. Suture unraveling occurred exclusively with the MFTT, while tendon laceration was observed only with the Krackow stitch.
Conclusion:
The DLKT demonstrated biomechanical performance comparable to the Krackow stitch under clinically relevant loading conditions and superior to the MFTT. DLKT provides a reliable needleless option for tendon graft handling and tensioning with predictable failure behavior without suture unraveling.
