Reconstruction of Bilateral Chronic Triceps Brachii Tendon Disruption Using a Suture-Mediated Anatomic Footprint Repair in a Dog.

A 2-year-old, intact female Pomeranian presented with bilateral forelimb lameness, characterized by the olecranon making contact with the ground. The patient experienced two separate incidents of falling, occurring four and three weeks before admission, respectively. Following each episode, non-weight-bearing lameness was initially observed in the left forelimb, followed by the development of crouch gait. Based on the physical examination, radiographic, and ultrasonographic findings, bilateral triceps brachii tendon disruption was diagnosed. Intraoperatively, excessive granulation tissue at the distal end of the tendon was excised. The footprint region of each triceps brachii tendon was decorticated with a high-speed burr until bleeding was observed. The triceps brachii tendon was reattached to completely cover its footprint on the olecranon using the Krackow suture technique. This method involves anchoring the suture through bone tunnels in the ulna. Trans-articular external skeletal fixation was applied to both forelimbs to immobile and stabilize the elbow joints for nine weeks. Subsequently, the dog gradually increased its walking activities while on a leash over a six-week period. At the three-year follow-up, the patient exhibited improved forelimb function and maintained a normal gait without signs of lameness. Suture-mediated anatomic footprint repair proved useful in this single case and may be an effective surgical alternative for the management of chronic triceps brachii tendon disruption in dogs.

Management of Chronic Patella Tendon Tear with Heterotopic Ossifications: A Case Report and Pictorial Review of Various Techniques in Contemporary Practice.

Purpose: To review reliable techniques for reconstructing or repairing chronic patella tendon tears and describe the unique case report of chronic patellar tendon tear with heterotopic ossification (HO). Case description: A 47-year-old male presented with chronic patellar tendon tears with HO, resulting in an inability to extend the right knee fully. Krackow suture repair augmented by autograft semitendinosus and gracilis was employed after debriding intra-substance patella tendon HO and fibrotic tissue. The repair was augmented using a method described by Chen et al. Postoperative recovery was uneventful, and the patient demonstrated an excellent Knee Society Score (86/100) at 6 months of follow-up. Proximal migration of the patella, poor tissue quality, scar tissue formation, and quadriceps atrophy pose unique challenges in managing chronic patellar tendon tears. Conclusion: HO increased the probability of patella baja after the reconstruction. To alleviate that, precise pre-op planning, careful method selection, and proper execution of the selected method are very important. A comprehensive review of 14 different methodologies for managing chronic patellar tendon tears, comprising eight case series and six case reports, was conducted. The selection of an appropriate technique should be based on individual patient characteristics, resource availability, and the surgeon's expertise.

A Case of Chronic Rupture of Achilles Tendon Managed Using a Combination of Multiple Surgical Techniques.

Achilles tendon rupture is a common injury that occurs due to sudden dorsiflexion of the plantar-flexed foot. Both acute and chronic ruptures are frequently misdiagnosed and mistreated. Acute Achilles tendon rupture commonly occurs in middle-aged individuals (30-40 years). Although several operative procedures are available for Achilles tendon repair, the management of choice remains controversial and debatable. A 27-year-old male came to our clinic complaining of pain over the left ankle for the last five months. History revealed trauma caused by a heavy metal object five months ago. Physical examination revealed tenderness and swelling over the left heel. Ankle plantar flexion was restricted, and painful and squeeze test was positive. Magnetic resonance imaging was suggestive of a tear of the Achilles tendon in the left ankle. Surgical management was done with multiple techniques which included flexor hallucis longus tendon graft augmentation, end-to-end suturing (Krackow technique), V-Y plasty, and bioabsorbable suture anchor. Although complications such as scar stiffness and wound gaping are common in such cases, the postoperative outcome was excellent in our case according to the American Orthopedic Foot and Ankle Score.

Jigless Knotless Internal Brace Versus Other Minimal Invasive Achilles Tendon Repair Techniques in Biomechanical Testing Simulating the Progressive Rehabilitation Protocol.

The jigless knotless internal brace surgery (JKIB), an alternative method for minimal invasive surgery (MIS) repair of acute Achilles tendon rupture, has advantages of preventing sural-nerve injury in MIS and superficial wound infection in open surgery, as previous clinical research demonstrates. However, no comparative study on the biomechanical performance between JKIB and other MIS techniques has been reported until now. In this study, 50 fresh porcine Achilles tendons were used to compare the JKIB with open surgery (two-stranded Krachow suture) with other MIS techniques, including Percutaneus Achilles Repair System (PARS), Speedbridge (SB), and Achillon Achilles Tendon Suture System (ACH), using a biomechanical testing with cyclic loading at 1 Hz. This test was used to simulate a progressive rehabilitation protocol where 20 to 100 N was applied in the first 250 cycles, followed by 20 to 190 N in the second 250 cycles, and then 20 to 369 N in the third 250 cycles. The cyclic displacement after 10, 100 and 250 cycles were recorded. The survived cycles were defined as a sudden drop in measured load. In survived cycles, the JKIB group (552.3 ± 72.8) had significantly higher cycles than the open, PARS, and ACH groups (204.3 ± 33.3, 395.9 ± 96.0, and 397.1 ± 80.9, respectively, p < .01) as analyzed by post hoc analysis, but no significant difference as compared with the SB group (641.6 ± 48.7). In cyclic displacement after 250 cyclic loadings, the JKIB group (11.29 ± 1.29) showed no significant difference as compared with PARS, SB, and ACH groups (12.21 ± 1.18, 9.80 ± 0.80, and 11.57 ± 1.10 mm, respectively) and significant less displacement than the open group (14.50 ± 1.85, p < .01). These findings suggest that JKIB could be an option for acute Achilles tendon repair in the MIS fashion due to no larger cyclic elongation compared with other MIS techniques.

A Novel Technique for the Treatment of Inferior Pole Fractures of the Patella: A Preliminary Report.

OBJECTIVE: Most inferior pole fractures of the patella are comminuted. Therefore, an ideal treatment method has not been determined. We have presented a modified tension band fixation technique-the Krachow suturing, Nice knot combined with tension band fixation-and reported the results of the procedure. METHODS: A total of 16 inferior patellar pole fractures were treated at our institution between January 2019 and October 2020, 15 of which underwent treatment with the modified tension band fixation technique consisting of Krachow suturing with Nice knots combined with tension band fixation. The primary measures: knee motion, Bostman score, anterior knee pain, fixation failure. RESULTS: Bone union occurred at a mean of 9 weeks postoperatively (range: 8-13). There were no cases of postoperative anterior knee pain, refracture of the inferior patellar pole or wire breakage. The patients regained full ROM of the knee joint without functional deficits during follow-up; the mean ROM was 128.46° ± 7.07° (range: 113.4°-137.8°). At the last follow-up, all patients had a mean Bostman score of 28.40 ± 1.29 (range: 26-30), with an excellent score in 11 patients and a good score in four patients. CONCLUSION: The modified tension band fixation technique for the treatment of inferior patellar pole fractures is a simple and easy-to-perform surgical technique that provides stable fixation and good functional results.

Manejo de fracturas conminutas del polo distal de la patela con asas verticales de alambre: reporte de casos / Management of comminuted fractures of the distal pole of the patela with vertical wire loops: case report

INTRODUCCIÓN Las fracturas conminutas del polo distal de la patela representan un desafío para el cirujano de rodilla, pues no existe un tratamiento estándar que permita una rehabilitación acelerada. Recientemente se han descrito la osteosíntesis y la reinserción del polo distal utilizando asas de alambre verticales. MATERIALES Y MÉTODOS Presentamos dos casos de fractura conminuta del polo distal de la patela resueltos con asas de alambre verticales y modificaciones de esta técnica. RESULTADOS Se realizó osteosíntesis del polo distal de la patela, y se logró una reducción radiográfica satisfactoria, lo que permitió una rehabilitación acelerada, con un rango de movilidad progresivo a tolerancia desde el día siguiente tras la cirugía. Los pacientes lograron recuperar el rango de movimiento completo a los dos y tres meses de operados, evolucionaron satisfactoriamente, sin complicaciones relacionadas a esta técnica y sus variaciones, y recibieron el alta médica tras cuatro meses de la reducción y osteosíntesis. DISCUSIÓN Las técnicas tradicionales para el manejo de fracturas del polo distal implican consideraciones especiales en la rehabilitación y complicaciones asociadas. Se utilizó la técnica de asas de alambres verticales en dos pacientes: en uno de ellos, el procedimiento fue complementado con sutura tipo Krackow; y, en el otro, con una placa para minifragmentos, lo que permitió una rehabilitación acelerada y retorno precoz a sus actividades laborales. CONCLUSIÓN El uso de asas de alambre vertical aparece como una técnica segura, que permite una rehabilitación acelerada y un reintegro laboral precoz.

INTRODUCTION Comminuted fractures of the distal pole of the patella represent a challenge for the knee surgeon, as there is no standard treatment that enables accelerated rehabilitation. Osteosynthesis and reattachment of the distal pole using vertical wire loops has recently been described. MATERIALS AND METHODS We herein present two cases of omminuted fracture of the distal pole of the patella resolved with vertical wire loops and modifications of this technique. RESULTS Osteosynthesis of the distal pole of the patella was performed, achieving a satisfactory radiographic reduction and enabling accelerated rehabilitation, with a progressive range of motion the day after the surgery. The patients achieved full range of motion two and three months after surgery. They progressed satisfactorily, without complications related to this technique and its variations, and were discharged four months after the reduction and osteosynthesis. DISCUSSION The traditional techniques for the management of distal pole fractures involve special considerations regarding rehabilitation and associated complications. The vertical wire loop technique was used in two patients: in one of them, it was supplemented with a Krackow suture; and, in the other, with a mini-fragment plate, which enabled accelerated rehabilitation and early return to work. CONCLUSION The use of vertical wire loops appears to be a safe technique, which enables accelerated rehabilitation and early return to work.

Positional anterior sternoclavicular joint dislocation in the acceleration phase of throwing: a case report.

Positional anterior sternoclavicular joint (SCJ) dislocation is relatively rare and needs careful treatment. We report our course of treatment and tips for surgery in a case. The patient was a 16-year-old male outfield baseball player. Three years ago, he had 3 recurrent episodes of right shoulder dislocation. During these injuries, there were forward dislocations of the proximal right clavicle edge accompanied by a creaking sound during the throw acceleration period. Thereafter, the anterior dislocation of the SCJ occurred during the acceleration phase of throwing, and the SCJ naturally repositioned on the shoulder resting position. This situation lingered and he often felt shoulder apprehension during throws, so he opted for surgical treatment just 1 month after the first injury. We performed a modified version of the figure-of-8 technique reported by Wang et al, using the ipsilateral palmaris longus (PL) tendon. The bilateral edge of the PL was attached to a Krackow suture and passed through the bone tunnels opened at the proximal clavicle and proximal sternum so that it became a figure of 8 on the anterior of the SCJ. The stability of the SCJ was confirmed after the surgery.

Biomechanical evaluation of patellar tendon repair using Krackow suture technique.

BACKGROUND: Patellar tendon rupture is a potentially devastating injury. Surgical repair is the primary treatment recommended for the patients with patellar tendon ruptures. Given the tendon properties, the suture technique is critical for proper tissue repair. Providing adequate loading during early mobilization is essential to prevent tendon suture repair failure. Therefore, the current study evaluated the mechanical characteristics of various applied loadings on patellar tendon repair using Krackow suture via a porcine model. METHODS: Twelve fresh porcine hindlimbs with patellar tendon rupture were repaired by Krackow method using synthetic and non-absorbable No. 5 Ethibond sutures. Loadings of 100 and 200 N were applied during the cyclic loading test. A three-dimensional optical motion capture system was used to record the gap formation at the initial, 50th, 100th, 150th, 200th, 250th, 500th, 750th, and 1000th cycle. After cyclic loading, the specimen was loaded to failure under displacement control at a rate of 1 mm/s. RESULTS: Suture breakage was the primary failure mode in both loading conditions. After 1000 cyclic loadings of 100 N, the ultimate failure strength was 243.6 ± 25.8 N. However, the specimens tested under 200 N of loading failed before reaching 200 cycles. Under the 100 N loading, the largest gap deformation (1.89 ± 0.23 mm) and residual deformation (0.213 ± 0.183 mm) were found in the initial cycle. The average cumulative displacement was 5.13 mm from the initial cycle to the 100th cycle and 4.5 mm from the 250th to the 1000th cycle. CONCLUSIONS: Our findings can serve as reference values for further comparisons with various repair techniques or materials. This study suggests that the initially applied load after patellar tendon repair is an important risk factor of re-rupture.

Longer stitch interval in the Krackow stitch for tendon graft fixation leads to poorer biomechanical property.

PURPOSE: The purpose of this study was to analyze the effects of different intervals between stitch throws on tendon graft fixation with the Krackow stitch. METHODS: Forty-four porcine flexor profundus tendons were randomly divided into four groups of 11 specimens each. The Krackow stitch with various stitch intervals (2.5, 5.0, 7.5, and 10.0 mm) were evaluated, and named the K-2.5, K-5.0, K-7.5, and K-10.0 groups, respectively. A braided nonabsorbable suture was used to complete each suture-tendon construct. All specimens were pretensioned to 100 N for three cycles, cyclically loaded from 50 to 200 N for 200 cycles, and then finally loaded to failure. Elongation after cyclic loading, ultimate load to failure, and the mode of failure were recorded. RESULTS: There were significant differences in elongation after cyclic loading among the K-2.5 (31% ± 5%), K-5.0 (32% ± 4%), K-7.5 (34% ± 5%), and K-10.0 (41% ± 8%) groups ( p = 0.004); the post hoc analysis showed significantly smaller values in the K-2.5 and K-5.0 groups than in the K-10.0 group ( p = 0.002 and 0.003, respectively). The stitch interval was correlated with elongation after cyclic loading ( r = 0.52, p < 0.001). Ultimate loads to failure and cross-sectional area were not significantly different across the four groups. CONCLUSION: The Krackow stitch with stitch intervals of 2.5 and 5.0 mm had significantly smaller elongation after cyclic loading than with an interval of 10.0 mm in this porcine biomechanical study. The stitch interval was moderately correlated with elongation after cyclic loading.

[Effectiveness analysis of limited small incision with simple Krackow suture in treatment of acute closed Achilles tendon rupture].

Objective: To explore the effectiveness of limited small incision with simple Krackow suture in treatment of acute closed Achilles tendon rupture. Methods: Between October 2013 and July 2016, 25 cases with acute Achilles tendon rupture were repaired by simple Krackow suture via limited small incision. There were 21 males and 4 females with an average age of 33.6 years (range, 25-39 years). The left side was involved in 15 cases and the right side in 10 cases. The injury caused by sport in 22 cases and by falling in 3 cases. The time from injury to operation was 3-7 days (mean, 4.4 days). Physical examination showed that the Thompson sign and single heel raising test were positive. Results: The operation time was 30-60 minutes with an average of 39.2 minutes. All incisions healed by first intention. There was no complication of wound infection, deep vein thrombosis, tendon re-rupture, and sural nerve injury. All patients were followed up 9-20 months (mean, 14.2 months). The ankle and hindfoot score of American Orthopaedic Foot and Ankle Society (AOFAS) was 92-97 (mean, 94.9) after 9 months. The AOFAS score results were excellent in 13 cases, good in 9 cases, and fair in 3 cases. The range of motion of ankle joint was 49-58° with an average of 53.7°. All single heel raising tests were negative. Conclusion: The method of simple Krackow suture via limited small incision has the advantages of minimal injury, less incidence of re-rupture and sural nerve injury, quicker recovery and so on.

Clinical comparison of the two-stranded single and four-stranded double Krackow techniques for acute Achilles tendon ruptures.

PURPOSE: Several different Krackow stitch configurations have been used for acute Achilles tendon rupture repair. Although several biomechanical studies compared different Krackow stitch configurations, to our knowledge, no previous studies compared the clinical outcome of these different suture methods. Therefore, in this study, we aimed to compare the clinical outcomes and complications of the two-stranded single and four-stranded double Krackow techniques. METHODS: Sixty-eight consecutive patients who underwent open repair by using the four-stranded double Krackow (33 patients, group A) or the two-stranded single Krackow (35 patients, group B) techniques between September 2011 and August 2014 were reviewed retrospectively. The isokinetic strength of plantar flexion and dorsiflexion of both ankles was assessed on a Cybex dynamometer 3 and 6 months after surgery. Clinical outcomes were evaluated 3, 6, and 12 months post-operatively. RESULTS: No significant differences were found between the groups regarding patient demographics or activity levels prior to treatment. Significant differences in the Achilles tendon Total Rupture Score, the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot score, or the four-point Boyden scale were not found at any time during follow-up. Rerupture occurred only in one patient from group A. No significant differences were observed between the groups regarding the isokinetic plantar flexion and dorsiflexion strength at any time or any test speed. CONCLUSION: Equally favourable clinical outcomes and isokinetic muscle strength and a low complication rate were achieved with the two-stranded single Krackow technique as compared with the four-stranded double Krackow technique for acute Achilles tendon rupture repair. LEVEL OF EVIDENCE: III.

Surgical time for graft preparation using different suture techniques.

BACKGROUND: The purpose of the present study was to compare the operative time for graft preparation using different techniques for graft suturing. MATERIAL AND METHODS: Flexor profundus tendons were harvested from fresh pig hind-leg trotters. Three different suture techniques were investigated: the Krackow stitch (K), the Whipstitch (W), and the Modified Finger-Trap suture (MFT). Tendons were sutured starting at 10 mm from the distal free end of the tendon. The suture configurations of the Krackow stitch and Whipstitch were completed with five suture throws. According to the MFT technique, the suture was wrapped five times around the tendon over a distance of 30 mm. The time required to perform a complete suture on each tendon was measured. Five independent examiners of different levels of training measured the time required for graft preparation during 3 separate occasions to determine intraobserver repeatability and interobserver reproducibility. RESULTS: The mean time required for graft preparation following the Krackow technique was 69.1 seconds ± 18.3 SD (range 31.8-120). The Whipstitch technique took an average of 59.9 seconds ± 21.2 SD (range 27-93). The MFT suture required a mean of 29.3 seconds ± 11.4 SD for completing the suture (range 21.6-33). In all examiners the time required to complete the MFT suture was significantly less than the other suture techniques (p < 0.05). Intraobserver intraclass correlation coefficients for each examiner ranged from 0.72 to 0.83. CONCLUSION: Low graft preparation time is required to complete a MFT suture in a porcine tendon model. Further, time required for graft preparation using the MFT was shorter than other suturing techniques such as the Krackow and Whipstitch techniques. CLINICAL RELEVANCE: The MFT suture could be used for graft set-up with the main advantage of reducing the time required in comparison with other suture techniques.

Internal fixation of displaced inferior pole of the patella fractures using vertical wiring augmented with Krachow suturing.

BACKGROUND: We present the surgical technique of separate vertical wiring for displaced inferior pole fractures of the patella combined with Krachow suture and report the surgical outcomes. MATERIALS AND METHODS: Between September 2007 to May 2012, 11 consecutive patients (mean age, 54.6 years) with inferior pole fractures of the patella (AO/OTA 34-A1) were retrospectively enrolled in this study. Through longitudinal incision, all patients underwent open reduction and internal fixation by separate vertical wiring combined with Krackow suture. The range of motion, loss of fixation, and Bostman score were primary outcome measures. RESULTS: The union time was 10 weeks after surgery on average (range: 8-12). No patient had nonunion, loss of reduction and wire breakage. There was no case of wound problem and irritation from the implant. At final follow-up, the average range of motion arc was 129.4° (range: 120-140). The mean Bostman score at last follow-up was 29.6 points (range: 28-30) and graded excellent in all cases. CONCLUSION: Separate vertical wiring combined with Krackow suture for inferior pole fractures of the patella is a useful technique that is easy to perform and can provide stable fixation with excellent results in knee function.

Biomechanical evaluation of varying the number of loops in a repair of a physiological model of Achilles tendon rupture.

BACKGROUND: Numerous suturing techniques have been described to treat Achilles tendon ruptures. No prior studies have evaluated frayed tendon ends on construct strength and whether this allows for less extensile exposure. METHODS: Forty bovine Achilles tendons were divided into groups: 1 control and 4 experimental. Experimental groups were sectioned with ends frayed longitudinally in 2 mm intervals for 2 cm with no fraying for the control group. Four-stand Krackow sutures were used for repairs with 3 loops in the control group, 2 loops in frayed section for experimental groups, and varying numbers of loops (1-4) in healthy tendon. Samples were tested in loading cells at 100 N and 190 N for 1000 cycles. Gap width and maximum load failure were measured. RESULTS: Gapping was <5 mm in controls at 100 N-190 N, significantly lower than experimentals. Greatest gapping occurred in groups with 1-2 loops in healthy tendon (10.9-13.9 mm). Most early catastrophic failures (5/8) occurred in groups with 1-2 loops in healthy tendon. Two failures at 100 N occurred in 1-loop healthy tendons. The least failures occurred in controls (2/8), at 190 N. CONCLUSION: Suture loops incorporated into frayed tendon portions predisposed repairs to significantly greater gapping and lower maximal failure forces than 4-strand Krackow repairs in unfrayed tendons. CLINICAL RELEVANCE: We cannot recommend attempting more limited exposures with sutures in frayed tendon as this may lead to early repair failure. We provided a physiologic model utilizing frayed tendon ends that resembles in vivo Achilles tendon rupture.

Biomechanical evaluation of double Krackow sutures versus the three-loop pulley suture in a canine gastrocnemius tendon avulsion model.

OBJECTIVE: To compare two Krackow sutures with a three-loop pulley suture for the reattachment of canine gastrocnemius tendons, using a tendon avulsion model. STUDY DESIGN: In vitro biomechanical study. METHODS: Ten paired gastrocnemius tendons were severed at their insertions on the calcaneal tuberosity and repaired with either two modified Krackow sutures or a modified three-loop pulley suture. Sutures were placed in the tendon ends and through diverging bone tunnels in the medial and lateral processes of the calcaneal tuberosity. Tensile loads required to (a) create a 3-mm gap and (b) induce construct failure were measured. RESULTS: The mean load to achieve a 3-mm gap was 77.22 ± 9.72 and 55.85 ± 9.91 N, and to result in construct failure was 106.88 ± 12.74 and 80.86 ± 12.23 N for the Krackow and three-loop pulley suture patterns, respectively. These differences were statistically significant (P < 0.001 and P = 0.001, respectively). CONCLUSION AND CLINICAL RELEVANCE: Two Krackow sutures were superior to the three-loop pulley pattern in both resistance to 3-mm gap formation and load to failure in a canine gastrocnemius avulsion model. The prevention of gap formation is critical for the success of tenorrhaphy. These results indicate that a suture pattern using two Krackow sutures may be clinically superior to the three-loop pulley suture pattern in the repair of canine gastrocnemius avulsion. Further work is required to determine if this superiority is mirrored in the repair of other tendon avulsion or laceration scenarios.

Collagen ribbon augmentation of Achilles tendon tears: a biomechanical evaluation.

Early motion of a repaired Achilles tendon has been accepted to improve both clinical and biomechanical outcomes. It has been postulated that augmenting a primary Achilles tendon repair with a collagen ribbon will improve the repair construct's initial strength, thereby facilitating early motion. The purpose of the present study was to compare the failure load of Achilles tendon defects repaired with suture, with or without augmentation with a collagen ribbon. Ten matched pairs of cadaveric feet and tibiae underwent simulated Achilles tendon tear in the watershed area and were then repaired with 4-strand Krackow sutures only or were sutured and augmented with a box weave collagen ribbon xenograft. The specimens were prepared for testing by keeping the insertion of the Achilles to the calcaneus intact and dissecting the gastrocnemius at its origin, leaving the repair undisturbed. The mean load at failure for the augmented (suture plus collagen ribbon) specimens was 392.4 ± 74.9 N. In contrast, the mean load at failure for the suture-only (control) construct was 98.0 ± 17.6 N (p < .001). The augmented specimens demonstrated a greater mean strength of 4.1 ± 0.9 N (range 3.2 to 5.6). After cyclic loading, the mean gap across the Achilles repair was significantly smaller in the augmented group than in the control group (p = .006). We have concluded that box weave collagen ribbon augmentation of the primary suture Achilles tendon repairs can provide enhanced gap resistance and strength under cyclic loading and ramped tensile testing.

The application of anchor nail combined with Krackow suture technique in the treatment of flesh achilles tendon rupture / 中国医师进修杂志

Objective To explore and evaluate the advantages of anchor nail in the treatment of achilles tendon rupture.Methods The clinical data of 27 patients with fresh achilles tendon rupture who received the treatment of thread anchor nail from January 2007 to August 2010 was retrospectively analyzed.Among them,14 patients received Krackow method,7 patients received Lindholm method to repair achilles tendon,6 patients received anchor nail combined with Krackow suture technique repair of achilles tendon.Arner-Lindholm clinical evaluation criterion was used for objective evaluation.Results Twenty-seven patients got 1-36 ( 17.35 ± 5.70) months follow-up.According to the corresponding standard in the 14 cases using Krackow method,8 cases were excellent,2 cases were good,4 cases were bad,the excellent and good rate was 71.4％( 10/14);in the 7 cases using Lindholm method,5 cases were excellent,1 case was good,1 case was bad,the excellent and good rate was 85.7 (6/7) ; all of the 6 cases using anchor nail combined with Krackow suture technique repair of achilles tendon were excellent,the excellent and good rate was 100.0％(6/6).Postoperative incisions were primarily healing,joint range of motion were all right,without rigidity,gait were almost normal,without the secondary fracture of ligament.Conclusion Anchor nail combined with Krackow suture technique in the treatment of achilles tendon rupture has significant effect,it is worth to be popularized because of its preonunced effect.

Treatment of Acute Achilles Tendon Rupture Using Krackow Suture Technique / 대한족부족관절학회지

PURPOSE: We try to evaluate the clinical results of the acute Achilles tendon rupture treated with Krackow suture technique. MATERIALS AND METHODS:We reviewed 27 patients with acute Achilles tendon rupture treated between October 2005 and September 2007. There were 26 complete ruptures and 1 incomplete rupture. All were ruptured at tendinous area. There were 21 men and 6 women, and mean age was 38 years. We repaired ruptured Achilles tendon with Krackow suture technique. The results were evaluated with Arner-Lindholm scale for patients' satisfaction, strength of calf muscle power, calf circumference, and ankle motion. The average follow-up was 29 months. RESULTS:The patients' subjective clinical results was excellent in 25 cases and good in 2 cases. There were 15 cases of less than 1 cm, 6 cases of 1~3 cm, and 1 case of more than 3 cm in the calf circumference difference between the normal and affected leg. There were 20 cases of less than 5 degrees, and 2 cases of more 5 degrees in the difference of range of motion between the normal and affected ankle. We had an experience of postoperative deep infection in one diabetic patient. CONCLUSION: We had a good clinical result for acute Achilles tendon rupture treated with Krackow suture method. So we recommand Krackow suture technique for acute Achilles tendon rupture.