Superior biomechanical properties and tying time with the modified Prusik knot and Wittstein suture loop to the Krackow stitch

Abstract

Compared to the Krackow stitch, the modified Prusik knot and Wittstein suture loop had less elongation after cyclic loading and similar ultimate load to failure in this porcine in vitro biomechanical study. Shorter knot tying times were required to complete the modified rolling hitch, modified Prusik knot, and Wittstein suture loop than the Krackow stitch.

Does using high-tensile strength tape improve the fixation strength in tendon graft fixation with needleless suture wrapping techniques compared to a suture?

“…Some previous studies 9, 14,15 reported ultimate failure loads of 330-360 N in both the modified rolling hitch and modified Prusik knot groups; meanwhile, the rupture of sutures at the knot was the failure mode in all specimens in both groups. Similar to previous studies, 9,14,15 the present study found 401 + 27 N and 398 + 44 N ultimate failure loads in the MRS and MPS groups, respectively, and all specimens failed due to sutures broken at the suture knot. Regarding elongation after cyclic loading, however, the experimental results in our study seemed to be higher than those in the previous study.…”

“…In the present study, FiberWire (Arthrex, Naples, FL) sutures were used, whereas ULTRA-BRAID sutures (Smith & Nephew, MA, USA) were used in the previous study. 9 This study had a number of limitations. First, porcine flexor tendons, instead of human tendons, were used in this biomechanical study.…”

“…9,15,16 Previous biomechanical studies indicated that both the modified rolling hitch and modified Prusik knot can achieve equal elongation after cyclic loading and ultimate failure loads, 9,16 and both of them can achieve equal or superior biomechanical properties as compared to the Krackow suture. 9,15 Similar to previous studies, the present study showed that the MRS and MPS groups had equal elongation after cyclic loading and ultimate failure loads. Despite the fact that both the modified rolling hitch and modified Prusik knot are considered attractive alternatives for tendon graft fixation, our study suggested that tape-shaped sutures should not be used for these needleless suture wrapping techniques, especially the modified rolling hitch, due to the poor biomechanical properties found in the present study.…”

“…[13][14][15][16] Additionally, these techniques have also been proven to be less time-consuming. 9,13 From the biomechanical perspective, tape-type sutures can prevent sutures from pulling through the tendons. 17,18 Gnandt et al conducted a biomechanical study of tendon graft fixation with different suture techniques and found that high-tensile strength tape withstood a significantly higher load than a high-tensile strength suture during a single load to failure test when whipstitch and Krackow suture techniques were used.…”

Longer stitch interval in the Krackow stitch for tendon graft fixation leads to poorer biomechanical property

“…The aforementioned parameters were set based on previous studies. 2,5,11,14,16,[18][19][20][21] A violet line and two violet marks, respectively, made on the tendon at a point 5 cm from the distal end of the tendon and on both suture limbs where they extend from the tendon, served as indicators for measuring the elongation of each suturetendon construct. Elongation after cyclic loading for each sample was acquired by calculating the difference in distance between the violet line on the tendon and the violet marks on each suture after pretensioning and cyclic loading.…”