Chih-Kai Hong1, Cheng-Li Lin1,2, Jui-Ming Yang1,3, Chien-An Shih1, Yi-Chuan Chou1, Ming-Long Yeh2,4, Chen-Hao Chiang4,5, Wei-Ren Su6,7,8. 1. Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, Tainan, 70428, Taiwan. 2. Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan. 3. Department of Orthopaedic Surgery, Sin-Lau Christian Hospital, Tainan, Taiwan. 4. Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan. 5. Department of Orthopedic Surgery, Chiayi Christian Hospital, Chiayi, Taiwan. 6. Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Sheng-Li Road, Tainan, 70428, Taiwan. suwr@ms28.hinet.net. 7. Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan. suwr@ms28.hinet.net. 8. Medical Device R & D Core Laboratory, National Cheng Kung University Hospital, Tainan, Taiwan. suwr@ms28.hinet.net.
Abstract
INTRODUCTION: The purposes of the study were to compare (1) the biomechanical properties of the modified Prusik knot, Wittstein suture loop, and Krackow stitch fixation, and (2) the knot tying times for tendon graft fixation among the Krackow stitch, modified rolling hitch, modified Prusik knot, and Wittstein suture loop. MATERIALS AND METHODS: First, 33 fresh-frozen porcine flexor profundus tendons were randomly divided into three groups of 11 specimens. The experimental procedure was designed to assess elongation of the suture-tendon construct across the modified Prusik knot, Wittstein suture loop, and the Krackow stitch. Multistranded nonabsorbable sutures were used. Each specimen was pre-tensioned to 100 N for three cycles, cyclically loaded to 200 N for 200 cycles, and finally loaded to failure. Elongation, load to failure, and failure mode of each specimen were recorded. Second, the knot tying times for modified rolling hitch, modified Prusik knot, Wittstein suture loop, and Krackow stitch were investigated. The measurements were taken on three different occasions to account for intraobserver repeatability and interobserver reproducibility. RESULTS: The elongation after cyclic loading of the modified Prusik knot (22 ± 6%), Wittstein suture loop (25 ± 2%) were significantly smaller than the Krackow stitch (31 ± 5%) (p = 0.001 and 0.003, respectively). The failure loads of three groups were not significantly from one another. Meanwhile, the Krackow stitch group (80.9 ± 16.7 s) had significantly longer average procedure time than the modified rolling hitch group (9.2. ± 1.9 s) (p < 0.001), modified Prusik knot group (9.1 ± 1.8 s) (p < 0.001), and Wittstein suture loop group (9.0 ± 2.2 s) (p < 0.001). CONCLUSIONS: 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.
INTRODUCTION: The purposes of the study were to compare (1) the biomechanical properties of the modified Prusik knot, Wittstein suture loop, and Krackow stitch fixation, and (2) the knot tying times for tendon graft fixation among the Krackow stitch, modified rolling hitch, modified Prusik knot, and Wittstein suture loop. MATERIALS AND METHODS: First, 33 fresh-frozen porcine flexor profundus tendons were randomly divided into three groups of 11 specimens. The experimental procedure was designed to assess elongation of the suture-tendon construct across the modified Prusik knot, Wittstein suture loop, and the Krackow stitch. Multistranded nonabsorbable sutures were used. Each specimen was pre-tensioned to 100 N for three cycles, cyclically loaded to 200 N for 200 cycles, and finally loaded to failure. Elongation, load to failure, and failure mode of each specimen were recorded. Second, the knot tying times for modified rolling hitch, modified Prusik knot, Wittstein suture loop, and Krackow stitch were investigated. The measurements were taken on three different occasions to account for intraobserver repeatability and interobserver reproducibility. RESULTS: The elongation after cyclic loading of the modified Prusik knot (22 ± 6%), Wittstein suture loop (25 ± 2%) were significantly smaller than the Krackow stitch (31 ± 5%) (p = 0.001 and 0.003, respectively). The failure loads of three groups were not significantly from one another. Meanwhile, the Krackow stitch group (80.9 ± 16.7 s) had significantly longer average procedure time than the modified rolling hitch group (9.2. ± 1.9 s) (p < 0.001), modified Prusik knot group (9.1 ± 1.8 s) (p < 0.001), and Wittstein suture loop group (9.0 ± 2.2 s) (p < 0.001). CONCLUSIONS: 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.
Authors: Shahbaz S Malik; Darren Hart; Sara Parashin; Jason Peeler; Sheila McRae; Peter MacDonald Journal: Clin Orthop Relat Res Date: 2022-03-01 Impact factor: 4.755