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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...

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Autores principales: Frosch, Stephan, Buchhorn, Gottfried, Hawellek, Thelonius, Walde, Tim Alexander, Lehmann, Wolfgang, Hubert, Jan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2020
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.
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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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