Clinical comparison of the two-stranded single and four-stranded double Krackow techniques for acute Achilles tendon ruptures

Choi, Gi Won; Kim, Soo Hyun; Lee, Tae Hoon; Park, Se Hyun; Lee, Hee Seop

doi:10.1007/s00167-016-4265-0

Cited by 10 publications

(13 citation statements)

References 21 publications

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“…The mean age of the patient was 36.14 years (18-67), mean duration of symptom presented was 6.08 days (1 to 18). The average hospital stay after surgery was 5.56 days (4 to 11), and mean follow up at point A was 14.14 months (12)(13)(14)(15)(16)(17)(18) and at point B was 30.76 months (24-39).…”

Section: Resultsmentioning

confidence: 99%

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Outcome of surgical management of ruptured Achilles tendon

Acharya

Devkota

Shrestha

et al. 2018

J Patan Acad Health Sci

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Introductions: The incidence of Achilles tendon rupture has been increasing worldwide. The optimal management of this problem is controversial but the surgical intervention is being applied widely. Methods: We retrospectively analyzed patients who had Achilles tendon (AT) rupture treated surgically at Patan Academy of Health Sciences from January 2010 to December 2015. Functional outcome assessment of ankle was done by using American Orthopedic foot and Ankle Society Score (AOFAS). Results: Total 71 patients (male 45, female 26) had surgery for AT, 38 right and 33 left side. The mean age of the patient was 36.14 years (range 18-67 years). The mean AOFAS score was 83.32 (range 75-93) after first year follow up and 90.36 (range 80-99) after second year, difference was statistically significant (p<0.05). Conclusions: The study showed high AOFAS score for surgical management of ruptured Achilles tendon.

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Section: Resultsmentioning

confidence: 99%

“…Operative procedure was performed by end-to end repair of ruptured AT using two-stranded single Krackow suturing technique. 15 Postoperatively, patients were put on below knee plaster cast for six weeks. Followup for functional outcome was done at one and two years.…”

Section: Methodsmentioning

confidence: 99%

Outcome of surgical management of ruptured Achilles tendon

Acharya

Devkota

Shrestha

et al. 2018

J Patan Acad Health Sci

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“…Although there was only two strand Krachow suture in the proximal stump of JKIB, the looped percutaneous suture of distal stump increased the numbers of strand crossing the repair site in JKIB to six. Biomechanically, the number of strand between each group should be constant to made the result valid, but the four strand end to end Krachow suture is still the benchmark in Achilles open repair clinically [6,9,29,36,37]. Thus, it was still reasonable that the 4Sk was chosen as comparison.…”

Section: Discussionmentioning

confidence: 99%

“…Although the clinical outcome of the case series was well, the suture strength has not yet been validated. Accordingly, we chose the four-strand Krackow suture (4sK) for comparison since this suture is favored for open repair due to easily performed and well clinical outcome and in previous publication [29]. In addition, we chose the triple-bundle technique (TBS) as another suture for comparison because it was shown to be stronger than the 4sK suture in a biomechanical study [30].…”

Section: Introductionmentioning

confidence: 99%

Jigless knotless internal brace versus other open Achilles tendon repair under progressive rehabilitation protocol: A biomechanical study

Hsu

Hong

et al. 2021

Preprint

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Background The jigless knotless internal brace surgery (JKIB), a modified minimal invasive surgery (MIS) for acute Achilles tendon injury, showed the advantage of sural-nerve injury prevention in MIS and superficial wound infection in open surgery in previous clinical research. However, to date, biomechanical testing remains not yet validated. Materials and methods Sixty porcine fresh Achilles tendons were used to compare the JKIB with other open surgery techniques, the four-strand Krackow suture (4sK) and triple-buddle suture (TBS) in biomechanic testing with cyclic loading at 1 Hz. This approach simulated a progressive rehabilitation protocol where 20-100N was applied in the first 1000 cycles, followed by 20-190N in the second 1000 cycles, and then 20-369N in the third 1000 cycles. The cycles to the repair gap 2mm, 5mm and 10mm were recorded. The survival cycles was defined as repair gap achieving 10mm. Results With respect to survived cycles, a significant difference was found among the three groups, in which the TBS was the most robust, followed by the JKIB and the 4sK, with mean survived cycles were 2639.3 +/- 263.55, 2073.6 +/- 319.92 and 1425.25 +/- 268.96, respectively. Significant difference was defined via a post hoc analysis with the Mann–Whitney U test after the Bonferroni correction (p < 0.017). Conclusions The TBS was the strongest suture structure in acute Achilles tendon repair. However, the JKIB could be an option in acute Achilles tendon repair with the MIS technique due to it being more robust than the 4sK, which has been favored in open repair.

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“…Choi et al found equally favorable clinical outcomes, isokinetic muscle strength, and a low complication rate with the two-stranded single Krackow technique as compared with the fourstranded double Krackow technique for acute Achilles tendon rupture repair. 5 Using simulated early rehabilitation biomechanical testing, Van Dyke et al showed that Giftbox-modified Krackow Achilles repair technique with FiberWire suture was stronger and more resistant to gap formation at the repair site than combinations that incorporated the Bunnell stitch or Ultrabraid suture. 2 Hong et al found no difference in cyclic load and load to failure between needleless knot techniques and Krackow configurations.…”

Section: See Related Article On Page 663mentioning

confidence: 99%

Editorial Commentary: The Krackow Stitch: More Than 30 Years of Tendon Repair and Still Holding Strong

Sherman¹

2018

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Security at the suture-tendon interface is a critical component of soft tissue fixation. For more than 3 decades, the Krackow stitch has been considered the gold standard for soft tissue fixation. Modifications of the original configuration have withstood the test of time. Many have been evaluated in preclinical and clinical studies for multiple musculoskeletal applications. Most recently, double Krackow suture configurations have been shown to increase the ultimate failure load of the suture-tendon construct. I have learned this stitch and will add it to my soft tissue fixation arsenal.

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Clinical comparison of the two-stranded single and four-stranded double Krackow techniques for acute Achilles tendon ruptures

Abstract: III.

Cited by 10 publications

References 21 publications

Outcome of surgical management of ruptured Achilles tendon

Outcome of surgical management of ruptured Achilles tendon

Jigless knotless internal brace versus other open Achilles tendon repair under progressive rehabilitation protocol: A biomechanical study

Editorial Commentary: The Krackow Stitch: More Than 30 Years of Tendon Repair and Still Holding Strong

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