Suture Configurations With Greater Tendon Purchase Show Increased Time-Zero Fixation Strength in Endoscopic Proximal...

Area of Science:

• Orthopedic surgery
• Biomedical engineering
• Sports medicine

Background:

• Proximal hamstring tendon avulsions are injuries requiring surgical repair.
• Endoscopic techniques are increasingly used for these repairs.
• Suture configuration is critical for repair strength and success.

Purpose of the Study:

• To compare the biomechanical performance of four common suture configurations in endoscopic proximal hamstring tendon repair.
• Evaluate simple suture, horizontal mattress, Krackow, and modified Mason-Allen techniques.

Main Methods:

• Twenty-four cadaveric proximal hamstring tendons were used.
• Tendons were randomized into four repair groups (n=6 each).
• Uniaxial load-to-failure testing was performed to determine ultimate failure load and linear stiffness.

Main Results:

• Krackow and Mason-Allen configurations demonstrated significantly higher ultimate failure loads compared to simple sutures.
• Horizontal mattress sutures also showed a greater failure load than simple sutures.
• No significant differences in linear stiffness were observed among the configurations; suture pull-through was the primary failure mode.

Conclusions:

• Suture configurations with greater tendon purchase, such as Krackow and Mason-Allen, significantly enhance repair strength.
• Horizontal mattress sutures offer a strong and technically feasible alternative, especially when portal access limits locking configurations.
• Optimizing suture configuration in endoscopic hamstring repair is crucial for improving robustness and reducing failure rates.