Effect of Epitendinous Suture Augmentation to a Double Krackow Suture Pattern for Canine Gastrocnemius Tendon Repair

Introduction: Although three-loop-pulleys are commonly utilized clinically, Double Krackow (DK) sutures have recently demonstrated superiority regarding the patterns resistance to gap formation while requiring greater loads to failure.

Objective: The aim of the study is to evaluate the effect of a DK suture pattern, with and without epitendinous suture (ES) augmentation in a canine gastrocnemius tendon model.

Materials and Methods: Transverse tenotomy was performed and repaired with a DK or DK+ES. Yield, peak and failure force, stiffness, occurrence of 1- and 3-mm gapping and failure mode were examined.

Results: Yield, peak, and failure loads were greater for DK+ES group. Yield force was 48% greater (149.56 ± 53.26 N) compared with DK (101.27 ± 37.17 N; p = 0.0172). Peak force was 45% greater (p <0.0001). Failure force was 47% greater for DK+ES (193.752 ± 31.43 N). Construct stiffness was 36% greater for DK+ES (p = 0.04). 100% of DK and 83% of DK+ES group produced a 1-mm gap with 100% of DK and 33% DK+ES producing a 3-mm gap (p <0.001). Loads required to create a 3-mm gap were greater for DK+ES (p <0.013). Suture breakage occurred in 100% of DK which differed from DK+ES, where suture breakage (7/12) and tissue failure (5/12; p = 0.037) predominated.

Discussion/Conclusion: Augmentation of a primary DK repair with an ES significantly improved construct strength while increasing loads required to cause 1- and 3-mm gap formation, respectively. ES augmentation is a simple technique modification that should be recommended to significantly increase construct strength compared with DK alone for tenorrhaphy.

Acknowledgement: No proprietary interests or funding existed for this project.

Publication History

Article published online:
26 October 2022