Effect of Ankaferd Blood Stopper on muscle healing.

PURPOSE: Ankaferd Blood Stopper (ABS), which is a standardized mixture of herbal extracts obtained from five plants, has been proven as an efficient hemostatic agent and is still used in emergency situations. It is not known exactly if decreased bleeding has positive or negative effects on muscle healing and fibrosis, so the purpose of this study was to test the effect of ABS on muscle healing and morphology. METHODS: A total of 66 outbred Wistar rats were divided into three control and three experimental subgroups. In the experimental groups, ABS was sprayed on the cut surface of the soleus. In the control groups, a saline solution was sprayed on the cut surface of the soleus. Subgroups were euthanized after 2 weeks, 3 weeks and 4 weeks, respectively. In each subgroup, eight rats were used for the biomechanical study to determine muscle healing and three rats were used for the histopathological investigation. RESULTS: Although muscle strength in the control groups was lower than that of the experimental groups in early weeks, no differences were found between the control and the experimental groups at 4 weeks. CONCLUSIONS: ABS has no negative effect on muscle healing. We also observed that ABS accelerated muscle healing compared to the control group. ABS could be used in hemostasis of open fractures and elective orthopedic surgeries.

Impairments of postural stability, core endurance, fall index and functional mobility skills in patients with patello femoral pain syndrome.

BACKGROUND: Postural control allows performance of daily and sports activities. The previous studies show that postural sway inceases in orthopaedic injuries such as osteoarthritis and total knee arthroplasty. OBJECTIVE: To compare postural sway, risk of falling and function between individuals with and without patellofemoral pain syndrome (PFS). METHODS: This study included 22 subjects with patellofemoral pain syndrome, age-matched pain-free 22 females serving as a control group. Visual anolog scale and Kujala were used to evaluate the pain. Posturographic assesment was performed by Tetrax posturographic device. Biering Modified Sorenson test for extensor endurance and sit-up test for flexor endurance were used for the evaluation of trunk endurance. Timed get-up and go test was used for lower extremity function. The Student's t Test was used to compare variables between the groups. The Pearson correlation coefficients were calculated to examine correlation between the quantitative variables. RESULTS: Postural sway included eyes open without pillow, eyes open on pillow, eyes closed on pillow, risk of falling, function and postural stabilization included flexor endurance, extansor endurance are impared in patient with patellofemoral pain syndrome when compare to controls. In subjects with PFPS increased postural sway significantly associated with body mass index (r= 0.52), pain duration (r= 0.43), postural control (extansor endurance) (r= -0.50) and risk of falling (r= 0.62) on pillow with open eyes. In addition we found function significantly related with postural control (extansor endurance and flexor endurance) (r= -0.59 and r= -0.59) and risk of falling (r= 0.77)CONCLUSIONS: Decreased neuromuscular control of the trunk core and increased postural sway and falling risk were found in patients with PFPS. Patients may be evaluated for deficits in postural control and falling risk before treatment.

An alternative treatment method for defective pseudoarthrosis; evaluation of eight patients treated with Artelon+Kryptonite.

Pseudoarthrosis with bone loss is one of the most challenging orthopaedic problems for surgeons. Bone loss usually leads to technical difficulties during surgery due to instability in the fracture area. Eight patients with pseudoarthrosis of different long bones were operated on by the same surgeon. The median age was 53 years (25-61), and the median time period after the index operation was 21 months (12-72 months). Radiographic union was achieved in all patients in 3.62 months (2-5 months). Efficient healing with new bone formation was observed in all of the patients. The result of the current case series is promising. This treatment method can be used for the treatment of pseudoarthrosis without increasing morbidity. Long-term follow-up and larger case series are needed for evidence of the adequacy and reliability of this method of treatment.

The efficacy of semirigid hip orthosis in the delayed treatment of developmental dysplasia of the hip.

UNLABELLED: This study assessed the use of semirigid hip orthosis to stabilize the femoral head into the acetabulum in the delayed treatment of developmental dysplasia of the hip (DDH; Graf type IIb or more severe) under the age of 6 months. Ninety-eight hips from 75 patients (four boys, 71 girls) were evaluated retrospectively. The mean age at treatment initiation was 3.2±1.3 months (1-6 months). As the dysplastic hip matured into a type I hip, we applied the weaning regimen for 1 month. Seventy-two patients (96%) were treated successfully in 4.2±1.1 months (2-8 months). All of the failures were type IV hips. We did not detect any acetabular or femoral head pathology in the later follow-up. Semirigid hip orthosis is safe and effective as the first-line treatment method for delayed DDH except in type IV hips in patients under 6 months of age. LEVEL OF EVIDENCE: Level IV. Case series.

Functional treatment of developmental hip dysplasia with the Tübingen hip flexion splint.

OBJECTIVE: Developmental dysplasia of the hip (DDH) is a deformity that may cause to serious disability. Early diagnosis and early treatment are very important. Our aim is to report the outcomes of infants with DDH who were treated with the Tübingen hip flexion splint. MATERIALS AND METHODS: Retrospectively, 49 patients (45 female, four male; 60 hips) diagnosed with DDH were included in the study. For diagnosis, all patients underwent ultrasonography of the hip performed according to the Graf method. Infants whose hips were Graf type 2b or worse underwent orthotic treatment. Treatment success was defined as development into a mature hip (Graf type 1 on ultrasonography and no acetabular dysplasia apparent on the latest radiograph). RESULTS: Overall median age at the start of treatment was 18 weeks (14-25). Median total treatment time (from initial application of the splint to the end of weaning) was 17 weeks (14-20). Median duration of follow up was 13.5 months (8.5-31.5). Treatment was successful in 56/60 hips (93.3%). Of the 56 successfully treated patients, acetabular dysplasia was present early in follow up but later resolved in 4 patients. No complications were encountered in any patients in the study. CONCLUSION: The Tübingen splint provides abduction, but due to its different design it offers the advantages of preventing hip adduction and leaving the knee and ankle joints free. Our findings suggest that in infants with DDH, the Tübingen hip flexion splint is an effective form of treatment.

A new measurement method in Graf technique: prediction of future acetabular development is possible in physiologically immature hips.

BACKGROUND: Universal ultrasound screening has led to overtreatment and higher follow-up rates than are found with clinical examination alone because of high incidence of physiologically immature hips (type IIa) in the first weeks of life. The ability to predict future acetabular development in physiologically immature hips (type IIa) would therefore help to reduce overtreatment and unnecessary follow-up. METHODS: We described the γ-angle to assess the femoral head coverage by the acetabular roof, which is measured between the baseline defined by Graf and the cartilaginous edge line connecting the inferior point of the iliac bone (lower limb) to the medial corner of the acetabular labrum. We retrospectively analyzed ultrasonographic findings of infants with developmental dysplasia of the hip diagnosed in our hospital and infants with normal hips screened in our hospital. Group 1 (35 hips) consists of type IIa hips at initial examination and went on to develop into dysplastic hips at follow-up. Group 2 (279 hips) consists of type IIa hips at initial examination and went on to develop into normal hips (type I) at follow-up. RESULTS: The γ-angles of type IIa hips that developed into type I hip at follow-up ranged between 77 and 82. The γ-angles of type IIa hips that developed into hip dysplasia ranged between 72 and 78. All type IIa hips that had γ-angles >78 degrees developed into normal hips. We also observed that all type IIa hips that had γ-angles <77 degrees developed into dysplasia. CONCLUSIONS: The amount of cartilage mass covering the femoral head, which is a part of the acetabular roof, can therefore provide information about future acetabular development. This paper describes a new method of measurement (the γ-angle) that assesses the extent of the cartilage coverage of the femoral head, which can predict acetabular development. Its use would decrease the rates of unnecessary follow-up and treatment. LEVEL OF EVIDENCE: Level II (development of diagnostic criteria on the basis of consecutive patients).

Brachial artery transection associated with open elbow dislocation in a 12-year-old: a case report.

Although acute elbow dislocations are common orthopedic injuries, concomitant neurovascular injury is rare. Brachial artery transection can result from open elbow dislocation and responds well to vascular repair. Rapid evaluation and a high level of suspicion are essential to facilitate immediate treatment. Delay to identify vascular injury after elbow dislocation or reduction can potentially lead to limb ischemia, and potential loss of limb. We present a case of relatively rare transection of the brachial artery, with an accompanying traumatic open elbow dislocation in a 12-year-old boy.

Adjunctive hyperbaric oxygen therapy in the treatment of atrophic tibial nonunion with Ilizarov external fixator: a radiographic and scintigraphic study in rabbits.

OBJECTIVE: The aim of this experimental study was to determine the effects of adjunctive hyperbaric oxygen therapy (HBO) on atrophic tibial nonunion treatment using Ilizarov external fixator. METHODS: Twenty New Zealand white rabbits were randomly divided into two equal groups. A circular external fixator was applied to the right tibia of all the rabbits. A 5-mm bone block was resected and a tibial pseudarthrosis was obtained after a 6-month waiting period. The experimental group rabbits (n=10) underwent daily 2.5 ATA HBO therapy for 2 hours for 20 days and the control group rabbits (n=10) did not receive any corresponding treatment. Osteoblastic activity was evaluated with bone scintigraphy on days 30 and 90. Fracture healing was evaluated by plain radiographs on days 30 and 90. RESULTS: On Day 30, radiological scores were statistically similar in both groups (p=0.167). However, on Day 90, the experimental group displayed significantly higher radiological scores (p<0.001). Osteoblastic activity was also higher in the experimental group on both scintigraphic assessments (p=0.005 and p=0.001). CONCLUSION: The results of this study suggest that HBO can be used as a supplementary therapy in the management of atrophic tibial nonunion.

Utilization of axillary brachial plexus block in the postoperative rehabilitation of intra-articular fractures of the distal humerus.

OBJECTIVES: An effective rehabilitation program is essential to prevent joint stiffness and regain range of motion after surgical treatment of intra-articular fractures of the distal humerus. We evaluated the effect of a physiotherapy program on functional results, that involved passive resistive stretching exercises performed under axillary brachial plexus block after radiographic observation of bone union of intra-articular fractures of the distal humerus treated with open reduction and internal fixation. METHODS: The study included 21 patients (7 females, 14 males; mean age 34+/-5 years; range 21 to 57 years) who underwent open reduction and internal fixation for intra-articular fractures of the distal humerus. All the patients had closed fractures. Six patients had AO type C1, six patients had C2, and nine patients had C3 fractures. Surgical treatment consisted of a posterior incision, olecranon osteotomy, and fixation of the metaphyseal fragments using two reconstruction plates placed medially and laterally. Active range of motion exercises were started on the third postoperative day. To prevent early development of heterotopic ossification, passive range of motion exercises were avoided. Active stretching exercises were initiated three weeks after surgery. Upon radiographic observation of bone union, axillary brachial plexus block was performed. The physiotherapy program involved passive stretching exercises during nerve block, and active weight exercises after recovery from motor block. The catheter remained in the axillary region for three months, during which functional rehabilitation was continued 2-3 times a week on an outpatient basis. Functional results were evaluated according to the criteria of Jupiter et al. after a mean follow-up period of 31 months (range 24 to 46 months). RESULTS: All fractures united within a mean of 11.9 weeks (range 9 to 17 weeks) except for one type C3 fracture. Functional results were excellent in 10 patients (47.6%), good in eight patients (38.1%), moderate in two patients (9.5%), and poor in one patient (4.8%). Two patients with a moderate outcome had associated multiple fractures in the ipsilateral extremity. Distribution of the functional results according to the type of fractures were 4 excellent, 2 good in type C1; 4 excellent, 2 good in C2; and 2 excellent, 4 good, 2 moderate, and 1 poor in C3 fractures. The mean loss of elbow extension was 16 degrees. The mean elbow flexion, pronation, and supination were measured as 131 degrees, 90 degrees, and 75 degrees, respectively. None of the patients had nonunion at the olecranon osteotomy site, superficial or deep infection, or heterotopic ossification. Three patients developed transient ulnar nerve neuropraxia that resolved spontaneously during the follow-up period. There were no complications related to axillary catheterization. CONCLUSION: Following surgical treatment of intra-articular fractures of the distal humerus, a regular and pain-free physiotherapy program performed under axillary brachial plexus block on an outpatient basis increases patient compliance and enables early return to daily activities.

AO tension band technique application in proximal humerus fractures.

OBJECTIVES: The aim of this study was to report our functional results after an intramedullary Kirschner wires (K-wires) and tension band wiring combination for the treatment of a large group of humeral head fractures was performed. PATIENTS AND METHODS: Seventy-four patients (54 females, 20 males; mean age 42 years; range 24 to 73 years) who had proximal humerus fractures were treated with an intramedullary K-wire and tension band technique and were retrospectively analyzed. Fracture patterns were according to Neer classification type II in 43 patients, type III in 23 patients and type IV in five patients. The Constant-Murley shoulder score test was used to evaluate the function of both shoulders. The outcome was graded according to Neer's criteria. The pain score was determined with a 10-point visual analog scale. RESULTS: All fractures were healed (radiologically and clinically) within 3.6 months (range 2.5 to 4.7 months) after the surgery. In one patient, the cerclage wire was broken and in eight patients, K-wires produced impingement like symptoms that required a second procedure (wire removal) after healing. The results of the patients with regard to Constant-Murley score and Neer criteria were indifferent when the 6th and the 12th month data were compared (p<0.05). Visual analog scale scores of the patients between the two control visits were significant different (p>0.05). CONCLUSION: The type of fixation depends on the bone quality and the degree of comminution. But the recent trend is towards osteosynthesis -the limited, less invasive technique- which is performed with minimal soft tissue dissection and minimal osteosynthesis. It allows less stripping of bone and therefore preservation of the blood supply to the humeral head. This procedure is simple to perform and provides good postoperative results.

Sonographic evidence for the absence of abductor pollicis longus, extensor pollicis longus, and brevis.

Complete absence or variations of extensor pollicis brevis and abductor pollicis longus; absence of the extrinsic extensors, abductor pollicis longus, thenar muscles along with congenital hypoplasia of the thumb; absence of flexor pollicis brevis and abductor pollicis brevis; and bilateral absence of extensor pollicis have been reported previously. Those cases mainly comprised absence/variations of the first extensor compartment either with or without thumb anomalies. This article presents a case of a patient in which the constituents of the first and third compartments (extensor pollicis brevis, abductor pollicis longus and extensor pollicis longus) were absent unilaterally. Herewith, we also highlight the role of static/dynamic sonography for prompt imaging in this regard.A 24-year-old man presented with difficulty using the left thumb. He reported no trauma and had not used the affected thumb since childhood. On physical examination, the left thumb was observed to be in flexion and opposition. He was unable to perform active extension and abduction but passive motion was free. Neurological examination of the left upper extremity was unremarkable. No organ anomaly was present on systemic examination. Radiographs of the left hand revealed no joint problems or hypoplasia. Ultrasonographic evaluation was consistent with absence of the first and third extensor compartment tendons. Tendon transfer was recommended but the patient refused surgery.

Double plate osteosynthesis provides better biomechanical stabilization than double tension band technique in distal humerus fractures.

OBJECTIVES: In this study we evaluated the stability and effectiveness of the double tension band osteosynthesis technique compared to the double plate osteosynthesis technique used for fixation of distal humerus fractures. MATERIALS AND METHODS: The study was performed on two groups, and in each group eight cadaveric, elderly (mean age 70-80) human humeri was used. An osteotomy was performed in the supracondylar region using a manual saw. The first group (group 1) was fixed with double 3.5 mm reconstruction plates, while the second group (group 2) was fixed with the double tension band technique, using crossing Kirschner wires. The osteotomy was designed so that the distal fragment would allow only a single screw per plate. The constructs were evaluated using a material testing machine. A linear non-cyclic load was applied until the failure of the constructs. The force which produced a 3 mm gap (3 mm gap strength), as detected visually with the aid of operating loupes, and the maximum load prior to failure of the fixation (maximum force) were measured from all tests. RESULTS: The mean value for the 3 mm gap strength was 1356.29+/-226.97 N for group 1 and 882.63+/-305.21 N for group 2. The mean value of the maximum load strength was 1487.13+/-298 N for group 1 and 1232+/-107.62 N for group 2. There were significant differences in 3 mm gap strengths of the two groups (p=0.005). There was also a significant difference in the maximum load between the two groups (p=0.016). CONCLUSION: Double plate osteosynthesis technique is superior to double tension band osteosynthesis for the fixation of distal humerus fractures.

Immobilization of the shoulder in external rotation for prevention of recurrence in acute anterior dislocation.

OBJECTIVES: We aimed to compare the functional and stability outcomes of the patients with acute anterior shoulder dislocation, who were stabilized at external versus internal rotation. METHODS: A total of 33 patients (31 males and 2 females) with the diagnosis of acute primary traumatic anterior shoulder dislocation were immobilized at internal (n=17) or external rotation (n=16). The mean follow-up period was 20.85 months (range 6-41 months). Patients received rehabilitation program immediately after splinting. We assessed functionality by Constant-Murlay score and stability by Rowe scoring system in 6th month. Control examinations were performed in 12th and 24th months. RESULTS: There were no statistically significant differences between internal rotation and external rotation groups in terms of Constant-Murlay and Rowe scores. Recurrent dislocation rate was 6.3% (1/16) in external rotation group and 29.4% (5/17) in internal rotation group (p>0.05). In the subgroup of patients aged between 21-30 years, while no recurrent dislocation was seen in external rotation group, 5 patients developed recurrent dislocation in internal rotation group(p=0.035). CONCLUSION: Immobilization of the shoulder in external rotation is an effective technique for prevention of recurrent dislocations in acute anterior shoulder dislocation and should be preferred to traditional splinting in internal rotation in clinical practice.

Biomechanical comparison of fixation of two-part osteoporotic neck fracture of the proximal humerus using uni-planar and multi-planar Kirschner wire.

OBJECTIVES: The stability and effectiveness of uni-planar Kirschner wire (K-wires) was compared to multi-planar K-wires osteosynthesis combined with tension band wiring for fixation of two-part osteoporotic surgical neck fracture of the proximal humerus. MATERIALS AND METHODS: Two groups each with eight cadaveric elderly (mean age 72.6; range 70 to 80 year) frozen human humeri were used in the study. Transverse osteotomy of the proximal humerus was performed using a thin oscillating saw. The first group (group A) was fixed using two anterograde smooth K-wires, sent from lateral cortex, combined with tension band wiring. The second group (group B) was fixed using multi-planar (anterograde and retrograde) four smooth K-wires combined with tension band wiring on the lateral cortex. Biomechanical tensile properties for 3 mm displacement (gap load) and maximum load were assessed. RESULTS: The mean value for the gap load was 1045.0+/-45.4 N (Newton) for group A and 1238.1+/-115.8 N for group B. Gap load values of groups were similar (p=0.01). The maximum load was 1261.8+/-52.4 N in group A and 1471.1+/-107.3 N in group B. The maximum load values were statistically higher in the multiplanar fixation technique (group B) when compared to that of the uniplanar fixation technique (group A), (p=0.004). CONCLUSION: Fixation in osteoporotic two-part surgical neck fractures of the proximal humerus using multiplanar K-wires combined with tension band wire provides substantially more effective stability compared to that of uniplanar fixation.

The prevalence of absence of the palmaris longus: a study in Turkish population.

INTRODUCTION: It is well known that there is a wide variation in the reported prevalence of the palmaris longus (PL) absence in different ethnic groups. This prospective study was conducted to determine the prevalence of absence of PL and correlate it with gender and body side in Turkish population. METHOD: In total, 1,350 randomly selected adult patients (675 men and 675 women) who admitted to our outpatient clinic were examined for the absence of PL using Schaeffer's test and Mishra's second test. The absence of PL on both sides, results of the first and second examination tests, age, gender and dexterity were recorded and analyzed statistically. RESULTS: The overall prevalence of absence of PL (unilateral or bilateral) was 26.6% in Turkish population. The absence of PL in women was statistically more common than men. Bilateral absence of PL was statistically frequent than unilateral absence. The prevalence of absence of PL was statistically similar between the body sides. CONCLUSION: Mishra's second test which involves resisted abduction of the thumb, may be better in demonstration of the PL where the muscle was feebly developed, particularly in women.

Acute traumatic open posterolateral dislocation of the ankle without tearing of the tibiofibular syndesmosis ligaments: a case report.

Pure open dislocation of the ankle, or dislocation not accompanied by rupture of the tibiofibular syndesmosis ligaments or fractures of the malleoli or of the posterior border of the tibia, is an extremely rare injury. A 62-year-old man injured his right ankle in a motor vehicle accident. Besides posterolateral ankle dislocation, there was a 7-cm transverse skin cut on the medial malleolus, and the distal end of the tibia was exposed. After reduction, we made a 2- to 2.5-cm longitudinal incision on the lateral malleolus; the distal fibular fracture was exposed. Two Kirschner wires were placed intramedullary in a retrograde manner, and the fracture was stabilized. The deltoid ligament and the medial capsule were repaired. The tibiofibular syndesmosis ligaments were intact. At the end of postoperative year 1, right ankle joint range of motion had a limit of approximately 5 degrees in dorsiflexion, 10 degrees in plantarflexion, 5 degrees in inversion, and 0 degrees in eversion. The joint appeared normal on radiographs, with no signs of osteoarthritis or calcification. The best result can be obtained with early reduction, debridement, medial capsule and deltoid ligament restoration, and early rehabilitation. Clinical and radiographic features at long-term follow-up also confirm good mobility of the ankle without degenerative change or mechanical instability.

Early and delayed treatment of dorsal transscaphoid perilunate fracture-dislocations.

OBJECTIVES: Transscaphoid perilunate fracture-dislocations are complex injuries. The aim of this study is to discuss and compare open reduction and internal fixation for acute and delayed transscaphoid perilunate fracture-dislocations and review the literature. DESIGN: The design of this study is retrospective and randomized. SETTINGS: Gülhane Military Medical Academy, Department of Orthopedics and Traumatology. PATIENTS/PARTICIPANTS: Twelve cases (6 acute and 6 delayed) of dorsal stage 2 fracture-dislocations were involved in the study. INTERVENTION: Scaphoid fractures were treated with reduction and internal fixation by using either a cannulated screw or a Herbert screw. Temporary triquetrocapitate and lunotriquetral fixation were performed in all cases using two 1.8-mm Kirschner wires after reduction of the dislocations. MAIN OUTCOME MEASUREMENT: Range of motion (flexion and extension), grip strength evaluation with Jamar dynamometer, comparison of preoperative and early postoperative average of scapholunate (SL) and radiolunate angle (RL), and revised carpal height ratio were used for outcomes assessment. Clinical evaluation was performed according to the clinical scoring system modified from Green and O'Brien. Revised carpal height ratio, SL angle, RL angle, and appearance of midcarpal arthritis were used for radiologic analysis. RESULTS: Average follow-up period was 45 months (23-70). Mean clinical score of early treated group and delayed treated group was 89.2 (good) and 72.5 (fair), respectively, according to clinical scoring system of Green and O'Brien. The overall clinical score of all cases was 80.8 (good). Two of the 6 cases in the delayed group developed posttraumatic midcarpal arthritis. Mean range of motion (flexion and extension) was 129.5 +/- 20.42 degrees in the early treated group and 95.5 +/- 18.08 degrees in the delayed group. Four of the 6 patients treated in the acute group gained normal grip strength, but 2 patients had more than 50% loss in grip strength compared with the contralateral wrist. Two of the 6 patients in the delayed group had normal grip strength, and 4 patients had more than 50% loss in grip strength compared with the contralateral wrist. The mean grip strength of the normal hands of all patients was 43.75 +/- 7.71 kg. The mean grip strength of the early treated group was 34.00 +/- 12.83 kg, whereas the mean grip strength of the delayed treated group was 26.33 +/- 13.48 kg. Average SL and RL angle in the early postoperative period were 47.5 and -9.40 degrees, respectively. At the last follow-up, average SL and RL angle were 55.5 and 5.43 degrees, respectively. The revised carpal height ratio was 1.51 in the early postoperative period and decreased to 1.45 at the last follow-up. CONCLUSIONS: We recommend open reduction and internal fixation for early and delayed transscaphoid perilunate fracture-dislocations.

Does strand configuration and number of purchase points affect the biomechanical behavior of a tendon repair? A biomechanical evaluation using different kessler methods of flexor tendon repair.

This study compares the mechanical properties of modified Kessler and double-modified Kessler flexor tendon repair techniques and evaluates simple modifications on both methods. Forty fresh sheep flexor tendons were divided equally into four groups. A transverse sharp cut was done in the middle of each tendon and then repaired with modified Kessler technique, modified Kessler with additional purchase point in the midpoint of each longitudinal strand, double-modified Kessler technique, or a combination of outer Kessler and inner cruciate configuration based on double-modified Kessler technique. The tendons were tested in a tensile testing machine to assess the mechanical performance of the repairs. Outcome measures included gap formation and ultimate forces. The gap strengths of the double-modified Kessler technique (30.85 N, SD 1.90) and double-modified Kessler technique with inner cruciate configuration (33.60 N, SD 4.64) were statistically significantly greater than that of the two-strand modified Kessler (22.56 N, SD 3.44) and modified Kessler with additional purchase configuration (21.75 N, SD 4.03; Tukey honestly significant difference test, P < 0.000). There were statistically significant differences in failure strengths of the all groups (analysis of variance, P < 0.000). With an identical number of strands, the gap formation and ultimate forces of the repairs were not changed by additional locking purchase point in modified Kessler repair or changing the inner strand configuration in double-modified Kessler repair. The results of this study show that the number of strands across the repair site together with the number of locking loops clearly affects the strength of the repair; meanwhile, the longitudinal strand orientation and number of purchase points in a single loop did not affect its strength.