Biomechanical Study of a Multifilament Stainless Steel Cable Crimp System Versus a Multistrand Ultra-High Molecular Weight Polyethylene Polyester Suture Krackow Technique for Achilles Tendon Rupture Repair |
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| Affiliation: | 1. Medical Student, School of Medicine, Stanford University, Palo Alto, CA;2. Medical Student, School of Medicine, University of California San Diego, La Jolla, CA;3. Assistant Professor, School of Medicine, University of California San Francisco, San Francisco, CA;4. Surgeon, Department of Anatomy and Orthopedics, University of California San Francisco, San Francisco, CA;5. Clinical Assistant Professor, Department of Orthopedic Surgery, Stanford University Medical Center, Palo Alto, CA;1. PGY-4 Orthopedic Resident, The University of Tennessee, Chattanooga, TN;2. Assistant Professor and Director of Foot and Ankle Surgery, The University of Tennessee, Chattanooga, TN;3. PGY-6 Orthopedic Fellow, Philadelphia Hand to Shoulder Center, Philadelphia, PA;4. Associate Professor and Program Director, Foot and Ankle Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL;1. Surgeon, Center for Joint Surgery, Southwest Hospital, Army Military Medical University, Chongqing, China;2. Nurse, Center for Joint Surgery, Southwest Hospital, Army Military Medical University, Chongqing, China;3. Professor, Center for Joint Surgery, Southwest Hospital, Army Military Medical University, Chongqing, China;4. Associate Professor, Center for Joint Surgery, Southwest Hospital, Army Military Medical University, Chongqing, China;1. Orthopedic Surgeon, Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea;2. Professor, Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea;3. Orthopedic Resident, Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea;1. Surgeon, Department of Orthopedic Surgery, Children''s Hospital, Zhejiang University School of Medicine, Hangzhou, China;2. Surgeon, Department of Orthopedic Surgery. The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China;3. Professor, Department of Cardiac Surgery. Children''s Hospital, Zhejiang University School of Medicine, Hangzhou, China;1. Resident Surgery, Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands;2. Assistant Professor and Research Coordinator, Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands;3. Trauma Surgeon, Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands;4. Professor, Department of Anatomy and Neurosciences, Erasmus MC, Rotterdam, The Netherlands;5. Professor, Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands |
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| Abstract: | Currently, Achilles tendon rupture repair is surgically addressed with an open or minimally invasive approach using a heavy, nonabsorbable suture in a locking stitch configuration. However, these sutures have low stiffness and a propensity to stretch, which can result in gapping at the repair site. Our study compares a new multifilament stainless steel cable-crimp repair method to a standard Krackow repair using multistrand, ultra-high molecular weight polyethylene polyester sutures. Eight matched pairs of cadavers were randomly assigned for Achilles tendon repair using either Krackow technique with polyethylene polyester sutures or the multifilament stainless steel cable-crimp technique. Each repair was cyclically loaded from 10 to 50 N for 100 loading cycles, followed by a linear increase in load until complete failure of the repair. During cyclic loading, 4 of the 8 Krackow polyethylene polyester suture repairs failed, whereas none of the multifilament stainless steel cable crimp repairs failed. Load to failure was greater for the multifilament stainless steel cable crimp repairs (321.03 ± 118.71 N) than for the Krackow polyethylene polyester suture repairs (132.47 ± 103.39 N, p = .0078). The ultimate tensile strength of the multifilament stainless steel cable crimp repairs was also greater than that of the Krackow polyethylene polyester suture repairs (485.69 ± 47.93 N vs 378.71 ± 107.23 N, respectively, p = .12). The mode of failure was by suture breakage at the crimp for all cable-crimp repairs and by suture breakage at the knot, within the tendon, or suture pullout for the polyethylene polyester suture repairs. The multifilament stainless steel cable crimp construct may be a better alternative for Achilles tendon rupture repairs. |
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