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A biomechanical comparison of Achilles tendon suture repair techniques: Locking Block Modified Krackow, Kessler, and Percutaneous Achilles Repair System with the early rehabilitation program in vitro bovine model

  • Arthroscopy and Sports Medicine
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Background

The Krackow technique has the advantage of high strength, though it is not minimally invasive. The “Locking Block Modified Krackow” (LBMK) peri-tendon fixation technique was designed for minimally invasive surgery. This study aimed to compare the biomechanics of LBMK with Kessler and Percutaneous Achilles Repair System (PARS) techniques using a simulated early rehabilitation program.

Materials and methods

Thirty-fresh bovine Achilles tendon specimens were randomly assigned to the LBMK, Kessler, and PARS groups (n = 10). In LBMK group, the main suture configuration was the LBMK technique, and the transverse suture was used as the secondary suture configuration. The Kessler group employed three suture configurations, two sagittal, one coronal plane. In the PARS group, two transverse and one locking sutures were placed at either end of the tendon. Each repaired specimen underwent two cyclic loading protocols (20–100 N, 20–190 N), 500 cycles, followed by measurement of the gap between the tendon ends. All specimens underwent a load-to-failure test at a 25 mm/s stretching rate.

Results

After the first loading cycle, the average gaps of the LBMK, Kessler and PARS groups were 0.76 ± 0.44 mm, 1.80 ± 0.82 mm, and 2.66 ± 1.04 mm, respectively. The LBMK group had a significantly reduced gap than the other groups (p < 0.01). The LBMK group gaps were all within 2 mm. The Kessler and PARS groups had six, and two specimens within 2 mm, respectively. After the second loading cycle, the average end gaps of the LBMK, Kessler, and PARS groups were 3.68 ± 1.08 mm, 5.70 ± 0.89 mm and 7.59 ± 1.26 mm, respectively. The LBMK group had a significantly reduced average gap than the other groups (p < 0.01). The maximum load-to-failure was highest 732.8 ± 138 N in the LBMK than the other groups (p < 0.01).

Conclusion

The biomechanical strength of the LBMK suture was significantly greater than Kessler and PARS. The reduced gap in the LBMK group suggests superior resistance to gap formation, which may occur during early postoperative rehabilitation.

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Acknowledgements

The authors would like to thank laboratory technicians Wen Zhang at the Orthopedics Institute, Soochow University for his help and cooperation.

Funding

This study was funded by the Science Foundation of Wuxi Health and Family Planning Commission (MS201743).

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Authors and Affiliations

  1. Department of Orthopedics, Soochow University Affiliated Wuxi Ninth People’s Hospital, Wuxi, China

    Jian Tian, Yongjun Rui, Yajun Xu, Tonglong Xu, Xueming Chen & Xingfei Zhang

  2. Department of Orthopedics, Nanjing Medical University Affiliated Nanjing First Hospital, Nanjing, China

    Wengbo Yang

Authors
  1. Jian Tian
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  2. Yongjun Rui
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  3. Yajun Xu
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  4. Wengbo Yang
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  5. Tonglong Xu
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  7. Xingfei Zhang
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by JT, TX, RR, YX, WY, XC and XZ. The first draft of the manuscript was written by JT and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Jian Tian.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

This study was reviewed and approved by the Ethics Review Board of Soochow University Affiliated Wuxi Ninth People’s Hospital. The Principles of laboratory animal care (NIH publication No. 86-23, revised 1985) were followed as well as any specific national laws where applicable.

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Tian, J., Rui, Y., Xu, Y. et al. A biomechanical comparison of Achilles tendon suture repair techniques: Locking Block Modified Krackow, Kessler, and Percutaneous Achilles Repair System with the early rehabilitation program in vitro bovine model. Arch Orthop Trauma Surg 140, 1775–1782 (2020). https://doi.org/10.1007/s00402-020-03535-y

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