Learning curve of the Krackow suture technique for the repair of Achilles tendon rupture

Whipstitch and Locking Stitch Show Equivalent Elongation and Load to Failure Across 3 Suture Systems in a Biomechanical Model of Quadriceps Tendon Grafts for Anterior Cruciate Ligament Reconstruction

Purpose

To compare the biomechanical properties of quadriceps tendon (QT) graft stitch methods using 3 different suture systems for anterior cruciate ligament reconstruction.

Methods

A total of 48 QTs were harvested from cadaveric knee specimens (age: 73 ± 7 years; range, 66-86 years). Samples were randomly divided into 3 groups where different suture needle systems were used to create 2 stitch methods: whipstitch (WS) and locking stitch (LS). Surgeons performed each technique to 5 stitches, each 0.5 cm apart. Stitching time was recorded. Samples were preconditioned and then underwent cyclic loading, followed by load to failure. Stiffness (N/mm), ultimate failure load (N), peak-to-peak displacement (mm), elongation (mm), and failure displacement (mm) were recorded.

Results

WS and LS were equivalent across stiffness, ultimate load, and peak-to-peak displacement within groups 2 and 3. In group 1, the LS was stiffer than the WS, but the WS achieved a higher ultimate load. For all groups, the LS achieved lower elongation and failure displacement than the WS, with significant differences in groups 1 and 2. Within each stitching method, equivalence was determined for total elongation and ultimate failure load for all 3 suture system groups. For WS samples, group 1 all failed from suture breakage, and both groups 2 and 3 had instances of failure from suture pull-through. All LS samples failed from suture breakage.

Conclusions

Both LS and WS provide adequate mechanical properties in each of the 3 suture systems. Differences in performance do exist; however, each method shows equivalent total elongation and ultimate failure load for all 3 suture systems. LS may be preferred over WS due to lower mean elongation and failure displacement.

Clinical Relevance

There is an increased use of QT grafts in for anterior cruciate ligament reconstruction. However, there have been a limited number of studies comparing various stitching methods and optimizing techniques for QT graft fixation. This study may provide important information to surgeons about which suture techniques have better biomechanical profiles.

The learning curve for minimally invasive Achilles repair using the "lumbar puncture needle and oval forceps" technique

INTRODUCTION

An acute Achilles tendon rupture represents a common tendon injury, and its operative methods have been developed over the years. This study aimed to quantify the learning curve for the minimally invasive acute Achilles tendon rupture repair.

METHODS

From May 2020 to June 2022, sixty-seven patient cases who received minimally invasive tendon repair were reviewed. Baseline data and operative details were collected. The cumulative summation (CUSUM) control chart was used for the learning curve analyses. Achilles tendon rupture score (ATRS), American Orthopedic Foot and Ankle Society (AOFAS) ankle/hindfoot score, and visual analog scale (VAS) at 3/6/9/12 months were calculated to assess the clinical outcomes.

RESULTS

Thirty-six cases underwent at least a year of follow up and were enrolled in this study. The gender ratio and average age were 80.5% and 32.5 years. The linear equation fitted well (R2 = 0.95), and CUSUM for operative time peaked in the 12th case, which was divided into the learning phase (n = 12) and master phase (n = 24). No significant difference was detected between the two groups in clinical variables, except for the operative time (71.1 ± 13.2 min vs 45.8 ± 7.2 min, p = 0.004). Moreover, we detected one case with a suture reaction and treated it properly.

CONCLUSION

Minimally invasive Achilles repair provides an opportunity for early rehabilitation. Notably, the learning curve showed that the "lumbar puncture needle and oval forceps" technique was accessible to surgeons.

Outcomes of early versus late functional weight-bearing after the acute Achilles tendon rupture repair with minimally invasive surgery: a randomized controlled trial

INTRODUCTION

Optimal postoperative rehabilitation regimen for acute Achilles tendon rupture (AATR) remains unclear. It is important to evaluate whether early functional weight-bearing rehabilitation program after minimally invasive repair results in an earlier return to pre-injury activity but increases the risk of re-rupture.

MATERIALS AND METHODS

This was a prospective randomized controlled trial involving 68 AATR patients undergoing minimally invasive surgery. 34 patients were enrolled in early weight‑bearing mobilization accelerated rehabilitation group (AR group); 34 patients were enrolled in the traditional rehabilitation (TR) group. Outcomes measures included American Orthopaedic Foot and Ankle Society Score (AOFAS) score and Achilles Tendon Total Rupture Score (ATRS) score before surgery and 3, 6, and 12 months after surgery, incidence rate of Achilles tendon re-rupture and total complications, length of hospital stay, time return to work and sports.

RESULTS

There was no significant difference in preoperative basic data between the two groups. However, AOFAS score and ATRS score were better in AR group than TR group at 3 months postoperatively (92.4 ± 3.5 vs 88.3 ± 4.5, P < 0.01; 91.1 ± 4.4 vs 88.9 ± 3.4, P = 0.03, respectively), the mean length of hospital stay (4.7 ± 1.5 vs 7.6 ± 2.0 days, P < 0.01) and time return to work (4.5 ± 1.0 vs 7.5 ± 1.6 weeks, P < 0.01) were shorter in AR group than in TR group. No statistical significance was calculated in patient-reported outcomes during the rest of the follow-up time and complications.

CONCLUSION

Early accelerated rehabilitation with weight-bearing in patients with AATR after minimally invasive surgery results in better early functional outcomes and shows similar security and feasibility.

REGISTRATION NO

ChiCTR2100043398.