title: Optimum locations of the locking loop and knot in tendon sutures based on the locking Kessler method.
abstract: BACKGROUND
  We investigated the factors that influence tensile strength and resistance to gap formation at the repair site of tendon suture (stiffness) by comparing (1) the location of the locking loops and (2) the location of the knot.
  
  
  METHODS
  Transected bovine tendons of the medial gastrocnemius (9-11 x 14-16 mm diameter) were sutured with a modified locking Kessler method with a USP (United States Pharmacopeial convention) 2 polyester multifilament suture (0.500-0.599 mm) and loaded to failure using an Instron 5565 tensiometer. The locking loops were located on either the upper surface facing the operator or on side portions of the tendon. The knot was positioned either close to or far from the tendon stump.
  
  
  RESULTS
  The locations of the locking loops did not influence the tensile strength; however, the stiffness of the side loop suture (5.70 +/- 0.09 N/mm) was significantly higher than that of the upper surface loop suture (5.17 +/- 0.10 N/mm). Regarding the knot location, the tensile strength with the knot far from the tendon stump (195.1 +/- 4.8 N) was significantly higher than that with the knot close to the tendon stump (169.0 +/- 3.6 N), although the stiffness was unchanged by differences in knot location.
  
  
  CONCLUSIONS
  These data suggested that a greater tensile strength with less of a gap is obtained by (1) forming locking loops in the side portion of the tendon, and (2) forming knots far from the tendon stump.
authors.affiliation: Department of Orthopaedics, Shimane University School of Medicine, 89-1 Enya-cho, Izumo 693-8501, Japan.
authors.forename: Tadahiko
authors.initials: T
authors.lastname: Yotsumoto
authors.forename: Ryuji
authors.initials: R
authors.lastname: Mori
authors.forename: Yuji
authors.initials: Y
authors.lastname: Uchio
mesh_terms: D000818:Animals; D002417:Cattle; D013536:Suture Techniques / Q000592:standards*; D013710:Tendons / Q000601:surgery*; D013718:Tensile Strength