The Double Krackow Suture Technique Does Not Offer a Significant Benefit Compared to the Krackow Suture Technique in Subpectoral Biceps Tenodesis Using a Double-Loaded Suture Anchor

Chih-Kai Hong; Kai-Lan Hsu; Fa-Chuan Kuan; Yueh Chen; Che-Chia Hsu; Ming-Long Yeh; Wei-Ren Su

doi:10.1016/j.arthro.2019.11.097

The Double Krackow Suture Technique Does Not Offer a Significant Benefit Compared to the Krackow Suture Technique in Subpectoral Biceps Tenodesis Using a Double-Loaded Suture Anchor

Arthroscopy. 2020 Mar;36(3):701-707. doi: 10.1016/j.arthro.2019.11.097. Epub 2020 Jan 20.

Authors

Chih-Kai Hong¹, Kai-Lan Hsu², Fa-Chuan Kuan², Yueh Chen³, Che-Chia Hsu¹, Ming-Long Yeh⁴, Wei-Ren Su⁵

Affiliations

¹ Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
² Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan.
³ Department of Orthopaedic Surgery, Sin Lau Hospital, Tainan, Taiwan.
⁴ Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan.
⁵ Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University. Electronic address: suwr@mail.ncku.edu.tw.

PMID: 31973990
DOI: 10.1016/j.arthro.2019.11.097

Abstract

Purpose: To compare the biomechanical properties of the double simple suture (DSS) technique, Krackow suture (KS) technique, and double Krackow suture (DKS) technique in subpectoral biceps tenodesis using a double-loaded suture anchor in a porcine tendon model.

Methods: A total of 30 artificial composite (polymer and glass fiber) humeri and porcine flexor profundus tendons with diameter of 4.5 mm were used. The sample size was determined based on the results of the pilot study. Metallic suture anchors with double-loaded No. 2 braided sutures were inserted at the subpectoral tenodesis site, 5 cm from the superomedial corner of the greater tuberosity. Three suture techniques were used to fix the tendons: a DSS used as the control, a KS, and a DKS, which is an alternative tendon graft fixation technique. A preload of 5 N was applied for 2 minutes, followed by cyclic loading for 500 cycles ranging from 5 to 70 N; next, a load-to-failure test at 1 mm/s was performed.

Results: The KS (283.5 ± 57 N) and DKS (270.4 ± 50 N) groups had significantly greater ultimate failure loads as compared with the DSS group (84.1 ± 6.4 N) (P < .001). Meanwhile, the peak displacement at failure loads in the KS group (9.3 ± 2.2 mm) and DKS group (7.8 ± 1.7 mm) were significantly smaller than that of the DSS group (11.3 ± 2.9 mm) (P = .015). Stiffness in the DSS group (36.4 ± 3.0 N/mm), KS group (39.6 ± 2.5 N/mm), and DKS group (36.9 ± 4.6 N/mm) was not significantly different (P = .125). All DSS constructs and 6 KS constructs failed with tendons being cut through by the sutures, whereas the other 4 KS constructs and all DKS constructs failed resulting from suture breakage.

Conclusions: In this subpectoral biceps tenodesis model, both the KS technique and the DKS technique had similar time 0 biomechanical properties that were better than those of the double simple suture technique.

Clinical relevance: A sturdy suture-tendon structure could prevent clinical failure of a subpectoral biceps tenodesis using a suture anchor.

Publication types

Comparative Study
Research Support, Non-U.S. Gov't

MeSH terms

Animals
Models, Animal
Suture Anchors*
Suture Techniques*
Swine
Tenodesis / methods*
Weight-Bearing*