Superior biomechanical properties and tying time with the modified Prusik knot and Wittstein suture loop to the Krackow stitch

Chih Kai Hong, Cheng-Li Lin, Jui Ming Yang, Chien An Shih, Yi Chuan Chou, Ming-Long Yeh, Chen Hao Chiang, Wei-Ren Su

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Introduction: The purposes of the study were to compare (1) the biomechanical properties of the modified Prusik knot, Wittstein suture loop, and Krackow stitch fixation, and (2) the knot tying times for tendon graft fixation among the Krackow stitch, modified rolling hitch, modified Prusik knot, and Wittstein suture loop. Materials and methods: First, 33 fresh-frozen porcine flexor profundus tendons were randomly divided into three groups of 11 specimens. The experimental procedure was designed to assess elongation of the suture-tendon construct across the modified Prusik knot, Wittstein suture loop, and the Krackow stitch. Multistranded nonabsorbable sutures were used. Each specimen was pre-tensioned to 100 N for three cycles, cyclically loaded to 200 N for 200 cycles, and finally loaded to failure. Elongation, load to failure, and failure mode of each specimen were recorded. Second, the knot tying times for modified rolling hitch, modified Prusik knot, Wittstein suture loop, and Krackow stitch were investigated. The measurements were taken on three different occasions to account for intraobserver repeatability and interobserver reproducibility. Results: The elongation after cyclic loading of the modified Prusik knot (22 ± 6%), Wittstein suture loop (25 ± 2%) were significantly smaller than the Krackow stitch (31 ± 5%) (p = 0.001 and 0.003, respectively). The failure loads of three groups were not significantly from one another. Meanwhile, the Krackow stitch group (80.9 ± 16.7 s) had significantly longer average procedure time than the modified rolling hitch group (9.2. ± 1.9 s) (p < 0.001), modified Prusik knot group (9.1 ± 1.8 s) (p < 0.001), and Wittstein suture loop group (9.0 ± 2.2 s) (p < 0.001). Conclusions: Compared to the Krackow stitch, the modified Prusik knot and Wittstein suture loop had less elongation after cyclic loading and similar ultimate load to failure in this porcine in vitro biomechanical study. Shorter knot tying times were required to complete the modified rolling hitch, modified Prusik knot, and Wittstein suture loop than the Krackow stitch.

Original languageEnglish
Pages (from-to)237-244
Number of pages8
JournalArchives of Orthopaedic and Trauma Surgery
Volume138
Issue number2
DOIs
Publication statusPublished - 2018 Feb 1

Fingerprint

Sutures
Tendons
Swine
Transplants

All Science Journal Classification (ASJC) codes

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

@article{dd4866bce4b947eb822f3193cd7ff826,
title = "Superior biomechanical properties and tying time with the modified Prusik knot and Wittstein suture loop to the Krackow stitch",
abstract = "Introduction: The purposes of the study were to compare (1) the biomechanical properties of the modified Prusik knot, Wittstein suture loop, and Krackow stitch fixation, and (2) the knot tying times for tendon graft fixation among the Krackow stitch, modified rolling hitch, modified Prusik knot, and Wittstein suture loop. Materials and methods: First, 33 fresh-frozen porcine flexor profundus tendons were randomly divided into three groups of 11 specimens. The experimental procedure was designed to assess elongation of the suture-tendon construct across the modified Prusik knot, Wittstein suture loop, and the Krackow stitch. Multistranded nonabsorbable sutures were used. Each specimen was pre-tensioned to 100 N for three cycles, cyclically loaded to 200 N for 200 cycles, and finally loaded to failure. Elongation, load to failure, and failure mode of each specimen were recorded. Second, the knot tying times for modified rolling hitch, modified Prusik knot, Wittstein suture loop, and Krackow stitch were investigated. The measurements were taken on three different occasions to account for intraobserver repeatability and interobserver reproducibility. Results: The elongation after cyclic loading of the modified Prusik knot (22 ± 6{\%}), Wittstein suture loop (25 ± 2{\%}) were significantly smaller than the Krackow stitch (31 ± 5{\%}) (p = 0.001 and 0.003, respectively). The failure loads of three groups were not significantly from one another. Meanwhile, the Krackow stitch group (80.9 ± 16.7 s) had significantly longer average procedure time than the modified rolling hitch group (9.2. ± 1.9 s) (p < 0.001), modified Prusik knot group (9.1 ± 1.8 s) (p < 0.001), and Wittstein suture loop group (9.0 ± 2.2 s) (p < 0.001). Conclusions: Compared to the Krackow stitch, the modified Prusik knot and Wittstein suture loop had less elongation after cyclic loading and similar ultimate load to failure in this porcine in vitro biomechanical study. Shorter knot tying times were required to complete the modified rolling hitch, modified Prusik knot, and Wittstein suture loop than the Krackow stitch.",
author = "Hong, {Chih Kai} and Cheng-Li Lin and Yang, {Jui Ming} and Shih, {Chien An} and Chou, {Yi Chuan} and Ming-Long Yeh and Chiang, {Chen Hao} and Wei-Ren Su",
year = "2018",
month = "2",
day = "1",
doi = "10.1007/s00402-017-2830-8",
language = "English",
volume = "138",
pages = "237--244",
journal = "Archiv fur orthopadische und Unfall-Chirurgie",
issn = "0003-9330",
publisher = "Springer Verlag",
number = "2",

}

Superior biomechanical properties and tying time with the modified Prusik knot and Wittstein suture loop to the Krackow stitch. / Hong, Chih Kai; Lin, Cheng-Li; Yang, Jui Ming; Shih, Chien An; Chou, Yi Chuan; Yeh, Ming-Long; Chiang, Chen Hao; Su, Wei-Ren.

In: Archives of Orthopaedic and Trauma Surgery, Vol. 138, No. 2, 01.02.2018, p. 237-244.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Superior biomechanical properties and tying time with the modified Prusik knot and Wittstein suture loop to the Krackow stitch

AU - Hong, Chih Kai

AU - Lin, Cheng-Li

AU - Yang, Jui Ming

AU - Shih, Chien An

AU - Chou, Yi Chuan

AU - Yeh, Ming-Long

AU - Chiang, Chen Hao

AU - Su, Wei-Ren

PY - 2018/2/1

Y1 - 2018/2/1

N2 - Introduction: The purposes of the study were to compare (1) the biomechanical properties of the modified Prusik knot, Wittstein suture loop, and Krackow stitch fixation, and (2) the knot tying times for tendon graft fixation among the Krackow stitch, modified rolling hitch, modified Prusik knot, and Wittstein suture loop. Materials and methods: First, 33 fresh-frozen porcine flexor profundus tendons were randomly divided into three groups of 11 specimens. The experimental procedure was designed to assess elongation of the suture-tendon construct across the modified Prusik knot, Wittstein suture loop, and the Krackow stitch. Multistranded nonabsorbable sutures were used. Each specimen was pre-tensioned to 100 N for three cycles, cyclically loaded to 200 N for 200 cycles, and finally loaded to failure. Elongation, load to failure, and failure mode of each specimen were recorded. Second, the knot tying times for modified rolling hitch, modified Prusik knot, Wittstein suture loop, and Krackow stitch were investigated. The measurements were taken on three different occasions to account for intraobserver repeatability and interobserver reproducibility. Results: The elongation after cyclic loading of the modified Prusik knot (22 ± 6%), Wittstein suture loop (25 ± 2%) were significantly smaller than the Krackow stitch (31 ± 5%) (p = 0.001 and 0.003, respectively). The failure loads of three groups were not significantly from one another. Meanwhile, the Krackow stitch group (80.9 ± 16.7 s) had significantly longer average procedure time than the modified rolling hitch group (9.2. ± 1.9 s) (p < 0.001), modified Prusik knot group (9.1 ± 1.8 s) (p < 0.001), and Wittstein suture loop group (9.0 ± 2.2 s) (p < 0.001). Conclusions: Compared to the Krackow stitch, the modified Prusik knot and Wittstein suture loop had less elongation after cyclic loading and similar ultimate load to failure in this porcine in vitro biomechanical study. Shorter knot tying times were required to complete the modified rolling hitch, modified Prusik knot, and Wittstein suture loop than the Krackow stitch.

AB - Introduction: The purposes of the study were to compare (1) the biomechanical properties of the modified Prusik knot, Wittstein suture loop, and Krackow stitch fixation, and (2) the knot tying times for tendon graft fixation among the Krackow stitch, modified rolling hitch, modified Prusik knot, and Wittstein suture loop. Materials and methods: First, 33 fresh-frozen porcine flexor profundus tendons were randomly divided into three groups of 11 specimens. The experimental procedure was designed to assess elongation of the suture-tendon construct across the modified Prusik knot, Wittstein suture loop, and the Krackow stitch. Multistranded nonabsorbable sutures were used. Each specimen was pre-tensioned to 100 N for three cycles, cyclically loaded to 200 N for 200 cycles, and finally loaded to failure. Elongation, load to failure, and failure mode of each specimen were recorded. Second, the knot tying times for modified rolling hitch, modified Prusik knot, Wittstein suture loop, and Krackow stitch were investigated. The measurements were taken on three different occasions to account for intraobserver repeatability and interobserver reproducibility. Results: The elongation after cyclic loading of the modified Prusik knot (22 ± 6%), Wittstein suture loop (25 ± 2%) were significantly smaller than the Krackow stitch (31 ± 5%) (p = 0.001 and 0.003, respectively). The failure loads of three groups were not significantly from one another. Meanwhile, the Krackow stitch group (80.9 ± 16.7 s) had significantly longer average procedure time than the modified rolling hitch group (9.2. ± 1.9 s) (p < 0.001), modified Prusik knot group (9.1 ± 1.8 s) (p < 0.001), and Wittstein suture loop group (9.0 ± 2.2 s) (p < 0.001). Conclusions: Compared to the Krackow stitch, the modified Prusik knot and Wittstein suture loop had less elongation after cyclic loading and similar ultimate load to failure in this porcine in vitro biomechanical study. Shorter knot tying times were required to complete the modified rolling hitch, modified Prusik knot, and Wittstein suture loop than the Krackow stitch.

UR - http://www.scopus.com/inward/record.url?scp=85032357037&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85032357037&partnerID=8YFLogxK

U2 - 10.1007/s00402-017-2830-8

DO - 10.1007/s00402-017-2830-8

M3 - Article

C2 - 29075842

AN - SCOPUS:85032357037

VL - 138

SP - 237

EP - 244

JO - Archiv fur orthopadische und Unfall-Chirurgie

JF - Archiv fur orthopadische und Unfall-Chirurgie

SN - 0003-9330

IS - 2

ER -