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.
Every time you place a Krackow stitch for an Achilles or patellar tendon repair, you are using the technique described in this 1986 brief note. The stitch was designed around three explicit failure modes of prior techniques: staples pull out of soft bone, simple sutures cut through weak interfibrous connections, and the Bunnell stitch purse-strings and strangulates tissue.
When working in osteoporotic bone — a TKA with soft metaphyseal bone, a frail patient with a quadriceps rupture. Augment the Krackow with a staple or second stitch rather than relying on either alone, as the paper shows this combination provides the highest pull-out strength.
The authors explicitly tied secure fixation to the emerging use of continuous passive motion after knee surgery: strong tendon-to-bone fixation is what makes early mobilization safe, not just technically possible.
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.
Every time you place a Krackow stitch for an Achilles or patellar tendon repair, you are using the technique described in this 1986 brief note. The stitch was designed around three explicit failure modes of prior techniques: staples pull out of soft bone, simple sutures cut through weak interfibrous connections, and the Bunnell stitch purse-strings and strangulates tissue.
When working in osteoporotic bone — a TKA with soft metaphyseal bone, a frail patient with a quadriceps rupture. Augment the Krackow with a staple or second stitch rather than relying on either alone, as the paper shows this combination provides the highest pull-out strength.
The authors explicitly tied secure fixation to the emerging use of continuous passive motion after knee surgery: strong tendon-to-bone fixation is what makes early mobilization safe, not just technically possible.