{'fraction_non_alphanumeric': 0.0330316742081448, 'fraction_numerical': 0.03076923076923077, 'mean_word_length': 4.64030612244898, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Biomechanical Analysis of Krackow Suture Fixation Strength of Cadaver Achilles Tendon with Loop Distance Variance of 5 mm, 7.5 mm, and 10 mm

LEVEL OF EVIDENCE: 3 SUMMARY Background. The incidence of Achilles tendon rupture continues to increase significantly from year to year. The Krackow technique for Achilles tendon repair has proven to be stronger than two clinical standards, Kessler modification technique, and Bunnel technique. However, the incidence of re-rupture and complications in the Krackow technique is still high if an earlier mobilization is carried out. From several studies, it appears that the distance between knots can affect the strength of suture fixation. The purpose of this study is to analyze: How does the difference in loop distance in Krackow suture affect the strength of suture fixation. Methods. This is a comparative analytic study with an experimental design. Cadaveric Achilles tendon was made rupture by 4 cm incision above its insertion. Then, it was repaired using Krackow suture with a loop distance of 5 mm (group 1), 7.5 mm (group 2), and 10 mm (group 3). Suture fixation strength was assessed with a standard load to failure test. The results were analyzed statistically using a one-way analysis of variance and post hoc test. Results and Discussion. The mean value of Krackow suture fixation strength in group 1 was 81.2±18.9 N, group 2 was 106.8±16.5 N, and group 3 was 132.3±28.6 N. There was statistically significant mean difference between the strength of tendon fixation in the loop distance of 5 mm, 7.5 mm and 10 mm (p-value=0.002). The most effective group was group 3 (10 mm) because it had the highest mean difference (51.10000, p = 0.000). Possible mechanisms that can increase the strength of tendon fixation in greater loop distance (10 mm) are a greater suture–tendon interaction, a more secure grip power of the sutures on the tendon surface, expanding stress concentration to the tendon surface area, and increased stiffness to counteract tensile forces. Conclusions. The 10 mm loop distance from the Krackow suture results in a significantly stronger suture fixation than the 7.5 mm and 5 mm loop distance for Achilles tendon rupture in cadaver.