The Addition of a Krackow Rip Stop Suture Augment After Achilles Tendon Debridement for Insertional Achilles Tendinopathy: A Biomechanical Study

Kelsey, Thomas J.; Mombell, LT Kyle W.; Fellars, CDR Todd A.

doi:10.1177/19386400211033693

Cited by 2 publications

(1 citation statement)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Vascular adaptations play a crucial role in the healing response after incision of the patellar tendon, and in turn, the strength of the tendon. [12][13][14][15] An understanding of the effect of suture placement on the vascularity has implications for postoperative healing.…”

Section: Introductionmentioning

confidence: 99%

Krackow Suture Technique Effect on Patella Tendon Vascularity: Quantitative MRI Analysis

Page

Stevens

Barth

et al. 2023

Journal of Orthopaedic Trauma

View full text Add to dashboard Cite

Objectives: To assess the effects of Krackow suture technique on the vascularity of the patellar tendon. Methods: Six fresh-frozen matched pair cadaveric knee specimens were used. The superficial femoral arteries were cannulated in all knees. The experimental knee underwent an anterior approach, patellar tendon transection from the inferior pole of the patella, 4-strand Krackow stitch placement, patellar tendon repair via 3-bone tunnels, and standard skin closure. The control knee underwent the identical procedure without Krackow stitching. All specimens then underwent precontrast and postcontrast enhanced quantitative magnetic resonance imaging assessment (with gadolinium-based contrast agent). Region of interest analysis was performed to assess for variation in signal enhancement between the experimental and control limbs in various patellar tendon regions and subregions. Latex infusion and anatomical dissection were performed to further evaluate vessel integrity and assess extrinsic vascularity. Results: Quantitative magnetic resonance imaging analysis demonstrated no statistically significant difference in overall arterial contributions. A small but nonsignificant decrease of 7.5% (SD ± 7.1%) in arterial contributions to the entire tendon was observed. Small nonstatistically significant regional decreases throughout the tendon were also detected. In the regional analysis, the largest to smallest decreases in arterial contributions after suture placement were found in the inferomedial, superolateral, lateral, and inferior tendon subregions. In the anatomical dissection, nutrient branches were seen dorsally and posteroinferiorly. Conclusion: The vascularity of the patellar tendon was not significantly affected by Krackow suture placement. Analysis demonstrated small and not statistically significant decreases in arterial contributions, suggesting this technique does not significantly compromise arterial perfusion.

show abstract

Section: Introductionmentioning

confidence: 99%

Krackow Suture Technique Effect on Patella Tendon Vascularity: Quantitative MRI Analysis

Page

Stevens

Barth

et al. 2023

Journal of Orthopaedic Trauma

View full text Add to dashboard Cite

show abstract

Single-Row Repair Versus Double-Row Repair in the Surgical Management of Achilles Insertional Tendinopathy: A Systematic Review

Ramelli,

Docter,

Kim

et al. 2024

Orthopaedic Journal of Sports Medicine

View full text Add to dashboard Cite

Background: Approximately 6% of people will report Achilles tendon pain during their lifetime, and one-third of these individuals will have Achilles insertional tendinopathy (AIT). For patients who have failed conservative treatment, surgical repair is performed. Achilles tendon repair can occur through various techniques, including a single-row or double-row repair. Purpose: To determine if there are significant advantages to double-row repair over single-row repair with respect to biomechanical and clinical outcomes. Study design: Systematic review; Level of evidence, 3. Methods: A systematic review of the literature was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. An electronic search of the EMBASE and PubMed databases was performed for all studies related to surgical treatment of AIT, which yielded 1431 unique results. These included both biomechanical and clinical studies. Clinical studies in which patients were not diagnosed with AIT, underwent surgery for repair of acute Achilles tendon rupture, or studies that included additional procedures such as a concomitant flexor hallucis longus transfer were excluded. Eligible studies were independently screened by 2 reviewers. A risk-of-bias assessment was conducted using the Cochrane Risk Of Bias In Non-randomized Studies–of Interventions and risk-of-bias tool for randomized trials tools. Results: A total of 23 studies were included, 4 of which were biomechanical studies and 19 were clinical studies. Biomechanical comparison found that there was a significant advantage to using double-row versus single-row fixation with respect to load at yield (354.7 N vs 198.7 N; P = .01) and mean peak load (433.9 N vs 212 N; P = .042). There was no significant difference between double-row and single-row repair with respect to load to failure. Significant heterogeneity of the studies did not allow for a statistical comparison of the clinical outcomes between double-row and single-row repairs. Conclusion: Although biomechanical studies favor double-row repair for AIT, the current data available on the clinical outcomes are not sufficient to determine if there is a clinical advantage of double-row repair. Larger, prospective randomized controlled trials utilizing validated outcome measures are needed to further elucidate whether the biomechanical advantages associated with double-row repair also translate into improved patient-reported outcomes.

show abstract

The Addition of a Krackow Rip Stop Suture Augment After Achilles Tendon Debridement for Insertional Achilles Tendinopathy: A Biomechanical Study

Cited by 2 publications

References 20 publications

Krackow Suture Technique Effect on Patella Tendon Vascularity: Quantitative MRI Analysis

Krackow Suture Technique Effect on Patella Tendon Vascularity: Quantitative MRI Analysis

Single-Row Repair Versus Double-Row Repair in the Surgical Management of Achilles Insertional Tendinopathy: A Systematic Review

Contact Info

Product

Resources

About