Krackow, J Bone Joint Surg Am 1986 - A New Stitch for Ligament-Tendon Fixation. Brief Note

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A New Stitch for Ligament-Tendon Fixation. Brief Note

Krackow, Jones, et al.·J Bone Joint Surg Am·1986·374 citations·Biomechanical study

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Krackow et al. describe a new locking-loop suture for attaching tendons, ligaments, and capsular tissue to bone. The technique was developed to overcome the failure modes of staple fixation and the Bunnell stitch, particularly in flat tendons and osteoporotic bone. The paper presents biomechanical testing, an in vivo rabbit model, and early clinical experience in over 50 patients.

Key Findings

A single locking-loop stitch outperformed both four simple interrupted sutures and staple fixation alone in ligament pull-out strength — establishing why this configuration became the reference standard for tendon repair.
Combining the locking stitch with a staple or a second stitch increased pull-out strength further beyond either alone, supporting the common practice of augmenting the Krackow with a staple at the bone fixation point — particularly relevant in osteoporotic bone where staple purchase alone is unreliable.
Biomechanical failure strengths compared favorably to published in vivo ligament tensile forces, meaning the construct tolerates physiologic loading — the prerequisite the authors explicitly tied to early mobilization and continuous passive motion protocols after knee surgery.
A rabbit in vivo model demonstrated a proliferative vascular response at repaired tendon-to-bone junctions, suggesting the stitch supports biologic healing in addition to mechanical fixation.
Clinical use in >50 patients over 2 years confirmed feasibility across multiple indications:
- Total knee arthroplasty capsule and ligament balancing (original indication)
- Trochanter reattachment
- Acute medial collateral ligament repair
- Quadriceps and patellar tendon rupture repair

Board PearlThe Krackow locking-loop stitch outperforms both four simple sutures and staple fixation alone in ligament pull-out strength testing.

A New Stitch for Ligament-Tendon Fixation. Brief Note.

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|

A New Stitch for Ligament-Tendon Fixation. Brief Note

Krackow, Jones, et al.·J Bone Joint Surg Am·1986·374 citations·Biomechanical study

|

Krackow et al. describe a new locking-loop suture for attaching tendons, ligaments, and capsular tissue to bone. The technique was developed to overcome the failure modes of staple fixation and the Bunnell stitch, particularly in flat tendons and osteoporotic bone. The paper presents biomechanical testing, an in vivo rabbit model, and early clinical experience in over 50 patients.

Key Findings

A single locking-loop stitch outperformed both four simple interrupted sutures and staple fixation alone in ligament pull-out strength — establishing why this configuration became the reference standard for tendon repair.
Combining the locking stitch with a staple or a second stitch increased pull-out strength further beyond either alone, supporting the common practice of augmenting the Krackow with a staple at the bone fixation point — particularly relevant in osteoporotic bone where staple purchase alone is unreliable.
Biomechanical failure strengths compared favorably to published in vivo ligament tensile forces, meaning the construct tolerates physiologic loading — the prerequisite the authors explicitly tied to early mobilization and continuous passive motion protocols after knee surgery.
A rabbit in vivo model demonstrated a proliferative vascular response at repaired tendon-to-bone junctions, suggesting the stitch supports biologic healing in addition to mechanical fixation.
Clinical use in >50 patients over 2 years confirmed feasibility across multiple indications:
- Total knee arthroplasty capsule and ligament balancing (original indication)
- Trochanter reattachment
- Acute medial collateral ligament repair
- Quadriceps and patellar tendon rupture repair

Board PearlThe Krackow locking-loop stitch outperforms both four simple sutures and staple fixation alone in ligament pull-out strength testing.

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