title: A Biomechanical Comparison of Modified Krackow and Locking Loop Suture Patterns for Soft-Tissue Graft Fixation.
abstract: The purpose of this ex vivo biomechanical study was to evaluate the tensile mechanical properties of 2 modified suture-graft constructs regarding elongation after pre-tensioning and cyclic loading as well as load to failure.
  
  
  
  Thirty fresh-frozen porcine Achilles tendons were randomly divided into 2 groups of 15 specimens to assess elongation of the suture-graft construct across 2 different tendon-grasping techniques: a modified locking SpeedWhip (MLS) stitch and a modified Krackow (MK) stitch. Each tendon was pre-tensioned to 89 N for 10 minutes and then cyclically loaded to 200 N for 200 cycles. Finally, each tendon was loaded to failure.
  
  
  
  After being pre-tensioned, the MK group elongated significantly more than the MLS group (7.12 ± 0.95 mm v 6.26 ± 0.94 mm, P = .02). Elongation after cyclic loading for the MK and MLS groups was not significantly different (3.39 ± 0.95 mm and 3.21 ± 0.93 mm, respectively; P > .05). The MK group showed a significantly larger load to failure compared with the MLS group (689 ± 61 N v 604 ± 46 N, P = .000024). The mean tendon cross-sectional area was larger in the MK group (399 ± 5 mm(2)v 393 ± 8 mm(2), P = .02), but this difference did not relate to the amount of elongation or load to failure. All but 1 specimen failed by suture breakage at the square knot.
  
  
  
  The MLS and MK stitches, pre-tensioned to 89 N for 10 minutes, both effectively minimized suture-graft construct elongation after cyclic loading. Consequently, both suture patterns are recommended for soft-tissue graft fixation.
  
  
  
  The MLS and MK suture configurations may provide sufficient biomechanical fixation of the tendon graft in the clinical setting of soft-tissue fixation without an interference screw.
authors.affiliation: Andrews Institute for Orthopaedics & Sports Medicine, Gulf Breeze, Florida, U.S.A.
authors.forename: Roger V
authors.initials: RV
authors.lastname: Ostrander
authors.affiliation: Andrews Institute for Orthopaedics & Sports Medicine, Gulf Breeze, Florida, U.S.A.. Electronic address: sig1375@gmail.com.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Saper
authors.affiliation: Andrews Institute for Orthopaedics & Sports Medicine, Gulf Breeze, Florida, U.S.A.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Juelson
mesh_terms: D000125:Achilles Tendon / Q000502:physiology / Q000601:surgery*; D000818:Animals; D001696:Biomechanical Phenomena / Q000502:physiology; D013536:Suture Techniques; D013552:Swine; D013718:Tensile Strength / Q000502:physiology