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Journal of Long-Term Effects of Medical Implants

ISSN Print: 1050-6934
ISSN Online: 1940-4379

Journal of Long-Term Effects of Medical Implants

DOI: 10.1615/JLongTermEffMedImplants.2016016536
pages 167-171

A Biomechanical Comparison of Different Tendon Repair Techniques

Jeffrey E. Mait
Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, Brooklyn, NY
Westley T. Hayes
Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center/University Hospital Brooklyn, Brooklyn, NY
Christopher L. Blum
Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, Brooklyn, NY
Robert Pivec
Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center/University Hospital Brooklyn, Brooklyn, NY
Christian J. Zaino
Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, Brooklyn, NY
Julio J. Jauregui
Center for Joint Preservation and Replacement, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland; Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center/University Hospital Brooklyn, Brooklyn, NY
Subrata Saha
Department of Biomedical Engineering, Florida International University, Miami, FL 33174; Affiliated Professor, Department of Restorative Dentistry, Affiliated Faculty, Department of Oral & Maxillofacial Surgery, School of Dentistry, University of Washington, Seattle, WA 98195
Jaime A. Uribe
Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center/University Hospital Brooklyn, Brooklyn, NY
William P. Urban
Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, Brooklyn, NY

ABSTRACT

Previous studies have examined multiple suture techniques for the repair of ruptured tendons. In this study, we investigated how the two- and four-stranded Krackow suture weave techniques compared with a novel Krackow/Bunnell suture technique. Our hypothesis was that the Krackow/Bunnell suture would have greater strength compared with the two- and four-stranded Krackow suture in terms of resistance to pullout from the muscle tendon. Thirty fresh bovine Achilles tendons were assigned randomly to three groups: (1) two-stranded Krackow, (2) fourstranded Krackow, and (3) the Krackow/Bunnell combination. After suture placement, all specimens were subjected to initial cyclic loading (0–200 N for 200 cycles) and then the tension to failure force defined as the pullout through the muscle tendon was evaluated. Significantly greater deformation before suture failure was seen in the Krackow/Bunnell group compared with the four-stranded Krackow construct (36.2 vs. 28.7 mm, p = 0.009), as well as greater energy required to rupture the suture (4635 vs. 3346 N/mm; p = 0.016). There was no significant difference with regard to the force to failure between the two groups (four-stranded Krackow vs. Krackow/Bunnell). The two-stranded Krackow was found to be inferior to both the four-stranded Krakow and the Krakow/Bunnell techniques with regard to load to failure. We have found that the Krackow/Bunnell suture technique is at least comparable to, if not superior to, the four-stranded Krackow technique with regard to deformation before suture failure and energy required to rupture the tendon. Therefore, the Krackow/Bunnell technique may be an optimal construct if the surgeon is concerned about suture pullout through the tendon; however, future studies evaluating this technique in the clinical setting are required before making any final conclusions for patient use.