DoD-VA Extremity Trauma and Amputation Center of Excellence, Walter Reed National Military Medical Center, Bethesda.
Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda.
Arthroscopy. 2021 Sep;37(9):2925-2933. doi: 10.1016/j.arthro.2021.04.016. Epub 2021 Apr 23.
To compare the biomechanical properties of high-tensile strength tape and high-tensile strength suture across 2 selected stitch techniques, the Krackow and whip stitch, in securing tendinous tissue during 5,000 cycles of nondestructive loading followed by a load to failure.
Fourteen matched pairs each of cadaveric Achilles, quadriceps, and patellar tendons (n = 84) were randomly assigned to either Krackow or whip stitch and sutured with either 2-mm high-tensile strength tape or No. 2 high-tensile strength suture. Specimens were preloaded to 20 N, cyclically loaded from 20 to 200 N for 5,000 cycles at 2 Hz, and then loaded to failure at 200 mm/min. Linear mixed models evaluated the effects of suture material and stitch technique on cyclic normalized tendon-suture elongation, total normalized tendon-suture elongation at 5,000 cycles, and maximum load at failure.
Across all suture constructs, normalized elongation was greater during the initial 10 cycles, compared with all subsequent cycling intervals (all P < .001). There was less total normalized elongation (β = -0.239; P = .007) and greater maximum load at failure in tape (β = 163.71; P = .014) when used in the Krackow stitch compared with the whip stitch.
Our findings indicate that tape used in the Krackow stitch maintains the most favorable fixation strength after enduring cyclic loading, with greater maximum load at failure. In addition, overall normalized elongation during long-term cyclic loading was predominately affected by the stitch technique used, regardless of the suture material; however, tape allowed less normalized elongation during the initial loading cycles, especially when placed in the whip stitch.
Understanding the potential short- and long-term outcomes of suture material and stitch technique on securing tendinous tissue under repetitive stresses can help inform clinicians on optimal tendon fixation techniques for early postoperative activities.
比较高强度胶带和高强度缝线在两种选定缝合技术（Krackow 缝合法和鞭状缝合法）下固定腱组织的生物力学性能，在 5000 次无损加载循环后，再进行失效负载，测试腱组织的性能。
将 14 对 cadaveric Achilles、quadriceps 和 patellar tendons（n = 84）随机分配到 Krackow 缝合法或鞭状缝合法，并用 2 毫米高强度胶带或 2 号高强度缝线缝合。标本预加载至 20 N，以 2 Hz 的频率从 20 到 200 N 循环加载 5000 次，然后以 200 mm/min 的速度加载至失效。线性混合模型评估缝线材料和缝合技术对循环标准化肌腱-缝线伸长率、5000 次循环总标准化肌腱-缝线伸长率和失效时最大负载的影响。
在所有缝线结构中，与所有后续循环间隔相比，初始 10 个循环中的标准化伸长率更高（均 P <.001）。在 Krackow 缝合法中使用胶带时，总标准化伸长率较低（β= -0.239；P=.007），失效时最大负载较高（β= 163.71；P=.014）。
我们的研究结果表明，在经受循环加载后，Krackow 缝合法中使用的胶带保持最有利的固定强度，失效时的最大负载较高。此外，长期循环加载过程中的总标准化伸长率主要受缝线材料的影响，而与缝合技术无关；然而，胶带在初始加载循环中允许的标准化伸长率较低，尤其是在鞭状缝合法中。
了解缝线材料和缝合技术在重复应力下固定腱组织的短期和长期结果，可以帮助临床医生了解最佳的腱固定技术，以便在术后早期进行活动。
