title: Biomechanical evaluation of double Krackow sutures versus the three-loop pulley suture in a canine gastrocnemius tendon avulsion model.
abstract: OBJECTIVE
  To compare two Krackow sutures with a three-loop pulley suture for the reattachment of canine gastrocnemius tendons, using a tendon avulsion model.
  
  
  METHODS
  In vitro biomechanical study.
  
  
  METHODS
  Ten paired gastrocnemius tendons were severed at their insertions on the calcaneal tuberosity and repaired with either two modified Krackow sutures or a modified three-loop pulley suture. Sutures were placed in the tendon ends and through diverging bone tunnels in the medial and lateral processes of the calcaneal tuberosity. Tensile loads required to (a) create a 3-mm gap and (b) induce construct failure were measured.
  
  
  RESULTS
  The mean load to achieve a 3-mm gap was 77.22 ± 9.72 and 55.85 ± 9.91 N, and to result in construct failure was 106.88 ± 12.74 and 80.86 ± 12.23 N for the Krackow and three-loop pulley suture patterns, respectively. These differences were statistically significant (P < 0.001 and P = 0.001, respectively).
  
  
  CONCLUSIONS
  Two Krackow sutures were superior to the three-loop pulley pattern in both resistance to 3-mm gap formation and load to failure in a canine gastrocnemius avulsion model. The prevention of gap formation is critical for the success of tenorrhaphy. These results indicate that a suture pattern using two Krackow sutures may be clinically superior to the three-loop pulley suture pattern in the repair of canine gastrocnemius avulsion. Further work is required to determine if this superiority is mirrored in the repair of other tendon avulsion or laceration scenarios.
authors.affiliation: Veterinary Teaching Hospital and Small Animal Clinic, School of Veterinary Science, The University of Queensland, St Lucia Campus, Queensland, 4072, Australia. l.wilson5@uq.edu.au.
authors.forename: L
authors.initials: L
authors.lastname: Wilson
authors.forename: Ta
authors.initials: T
authors.lastname: Banks
authors.forename: P
authors.initials: P
authors.lastname: Luckman
authors.forename: B
authors.initials: B
authors.lastname: Smith
mesh_terms: D000818:Animals; D001696:Biomechanical Phenomena; D004285:Dogs; D037901:Euthanasia, Animal; D018482:Muscle, Skeletal / Q000601:surgery*; D011897:Random Allocation; D013536:Suture Techniques / Q000662:veterinary*; D013537:Sutures / Q000592:standards / Q000662:veterinary*; D013710:Tendons / Q000601:surgery*; D014741:Video Recording; D014945:Wound Healing
keywords: Krackow suture; dogs; gastrocnemius tendon; tenorrhaphy; three-loop pulley suture