Comparison of Three Crural Fascia Repair Techniques for Tibial Tuberosity Advancement Surgery

Introduction: This study compares the strength of repair of the crural fascia following tibial tuberosity advancement surgery, using three described techniques, to the strength of paired intact limbs. We hypothesize there would be a biomechanical advantage to one of the repairs and all repairs would be weaker than intact controls.

Materials and Methods: Twenty-two canine cadavers were randomly assorted into three groups. Group A: a continuous suture pattern. Group B: five equally spaced simple interrupted cruciate sutures combined with a simple continuous suture pattern. Group C: an interrupted modified locking loop suture pattern. The mid-portion of the crural fascia was incised in Groups A and C while Group B used a cranial incision. Contralateral limbs were utilized as paired control. Tibiae were mounted to an Instron 4206 and loaded at 10 mm/min.

Results: Mean peak load to failure was: Group A: 20.5 kgf. Group B: 26.6 kgf. and Group C: 30.6 kgf. Intact limbs: 81.5 kgf. No significant difference between peak load to failure was identified between individual repair groups (p > 0.05). Significant differences were identified between all repair groups and intact limbs (p < 0.05). All repair groups approached a mean of 33.5% of intact muscle strength.

Discussion/Conclusion: Based on the results of this study, it is hypothesized that the best repair technique would be a combination of the crural fascia incision used in Group B and the repair used in Group C (modified locking-loop) in conjunction with a simple continuous suture pattern.

Acknowledgement: There was no proprietary interest or funding provided for this project.

No conflict of interest has been declared by the author(s).