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Comparison of the double loop knot stitch and Kessler stitch for Achilles tendon repair: A biomechanical cadaver study
Tendon elongation after Achilles tendon (AT) repair is associated with the clinical outcome. Reliable suture techniques are essential to reduce gap formations and to allow early mobilization. Cyclic loading conditions represent the repetitive loading in rehabilitation. The aim of this study was to c...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7714161/ https://www.ncbi.nlm.nih.gov/pubmed/33270745 http://dx.doi.org/10.1371/journal.pone.0243306 |
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author | Frosch, Stephan Buchhorn, Gottfried Hawellek, Thelonius Walde, Tim Alexander Lehmann, Wolfgang Hubert, Jan |
author_facet | Frosch, Stephan Buchhorn, Gottfried Hawellek, Thelonius Walde, Tim Alexander Lehmann, Wolfgang Hubert, Jan |
author_sort | Frosch, Stephan |
collection | PubMed |
description | Tendon elongation after Achilles tendon (AT) repair is associated with the clinical outcome. Reliable suture techniques are essential to reduce gap formations and to allow early mobilization. Cyclic loading conditions represent the repetitive loading in rehabilitation. The aim of this study was to compare the Kessler stitch and double loop knot stitch (DLKS) in a cyclic loading program focussing on gap formation. Sixteen human cadaveric ATs were transected and sutured using either the Kessler stitch or DLKS (eight matched pairs). The suture-tendon configurations were subjected to cyclic loading and additional ultimate load to failure testing using the Zwick 1446 universal testing machine. Each AT survived cyclic loading, with a mean gap formation less than 5 mm after 1000 cycles. The mechanical properties of the Kessler stitch and DLKS were not significantly different after cyclic loading with a mean displacement of 4.57 mm (± 1.16) for the Kessler stitch and 4.85 mm (± 1.14) for the DLKS (P = .76). There were no significant differences in the ultimate load testing (P = .85). Both bioprotective techniques prevent excessive gaping in cyclic testing when tendon loading is moderate. Our data and those from literature of gap formation in cyclic and ultimate loading allow the conclusion, that early aggressive AT loading after repair (e.g. full weightbearing) overstrain simple as well as complex suture configurations. Initial intraoperative tightening of the knots (preloading) before locking is important to decrease postoperative elongation. |
format | Online Article Text |
id | pubmed-7714161 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-77141612020-12-09 Comparison of the double loop knot stitch and Kessler stitch for Achilles tendon repair: A biomechanical cadaver study Frosch, Stephan Buchhorn, Gottfried Hawellek, Thelonius Walde, Tim Alexander Lehmann, Wolfgang Hubert, Jan PLoS One Research Article Tendon elongation after Achilles tendon (AT) repair is associated with the clinical outcome. Reliable suture techniques are essential to reduce gap formations and to allow early mobilization. Cyclic loading conditions represent the repetitive loading in rehabilitation. The aim of this study was to compare the Kessler stitch and double loop knot stitch (DLKS) in a cyclic loading program focussing on gap formation. Sixteen human cadaveric ATs were transected and sutured using either the Kessler stitch or DLKS (eight matched pairs). The suture-tendon configurations were subjected to cyclic loading and additional ultimate load to failure testing using the Zwick 1446 universal testing machine. Each AT survived cyclic loading, with a mean gap formation less than 5 mm after 1000 cycles. The mechanical properties of the Kessler stitch and DLKS were not significantly different after cyclic loading with a mean displacement of 4.57 mm (± 1.16) for the Kessler stitch and 4.85 mm (± 1.14) for the DLKS (P = .76). There were no significant differences in the ultimate load testing (P = .85). Both bioprotective techniques prevent excessive gaping in cyclic testing when tendon loading is moderate. Our data and those from literature of gap formation in cyclic and ultimate loading allow the conclusion, that early aggressive AT loading after repair (e.g. full weightbearing) overstrain simple as well as complex suture configurations. Initial intraoperative tightening of the knots (preloading) before locking is important to decrease postoperative elongation. Public Library of Science 2020-12-03 /pmc/articles/PMC7714161/ /pubmed/33270745 http://dx.doi.org/10.1371/journal.pone.0243306 Text en © 2020 Frosch et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Frosch, Stephan Buchhorn, Gottfried Hawellek, Thelonius Walde, Tim Alexander Lehmann, Wolfgang Hubert, Jan Comparison of the double loop knot stitch and Kessler stitch for Achilles tendon repair: A biomechanical cadaver study |
title | Comparison of the double loop knot stitch and Kessler stitch for Achilles tendon repair: A biomechanical cadaver study |
title_full | Comparison of the double loop knot stitch and Kessler stitch for Achilles tendon repair: A biomechanical cadaver study |
title_fullStr | Comparison of the double loop knot stitch and Kessler stitch for Achilles tendon repair: A biomechanical cadaver study |
title_full_unstemmed | Comparison of the double loop knot stitch and Kessler stitch for Achilles tendon repair: A biomechanical cadaver study |
title_short | Comparison of the double loop knot stitch and Kessler stitch for Achilles tendon repair: A biomechanical cadaver study |
title_sort | comparison of the double loop knot stitch and kessler stitch for achilles tendon repair: a biomechanical cadaver study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7714161/ https://www.ncbi.nlm.nih.gov/pubmed/33270745 http://dx.doi.org/10.1371/journal.pone.0243306 |
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