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Objective The study aim was to evaluate the clinical outcomes, functional outcomes, and postoperative complications of anchor and Krackow‐“8” suture fixation (AS) and K‐wire fixation in patients with distal pole patellar fractures. Methods Twenty‐eight patients with distal pole patella fractures between January 2011 and December 2014 were reviewed retrospectively. The anchor and Krackow‐“8” suture fixation (AS group) was applied in 10 patients and 18 patients underwent K‐wire fixation (K‐wire group). The average age of patients was 46.000 ± 19.476 years in the AS group and 47.556 ± 15.704 years in the K‐wire group, with comparable demographic characteristics. All patients underwent regular follow‐up the operative data and postoperative functional and clinical outcomes were recorded. Complications were recorded by clinical and radiographic assessment. Bostman patellar fracture functional score was used to evaluate knee function after patellar fracture. Results A total of 28 eligible patients were included in this study. The mean follow‐up was similar for the AS and the K‐wire groups (P > 0.05). The incision length of AS group was significantly smaller than that of K‐wire group (P < 0.05). The incision length of AS group was significantly smaller than that of K‐wire group (P < 0.05). The final follow‐up on the range of motion of the knee: the average extension lag was similar in two groups (P > 0.05); flexion and flexion–extension angle was slightly better in the AS group than in the K‐wire group. The Bostman patella fracture functional score of AS group were better than K‐wire group at 3 and 6 months after operation. Four kinds of postoperative complications in two groups, one patient (10%) in the AS group and two patients (11.1%) in the K‐wire group had infections. Two (11.1%) cases of nonunion in group K and three patients (16.7%) required re‐operation: one due to infection and two due to early implant failure. In the AS group, all distal pole fractures of the patella showed bony union, without loosening, falling, pulling out and nonunion of the fractures 6 months after operation. Conclusions Anchor and Krackow‐“8” suture fixation is an easily executed surgical procedure that can significantly reduce incision length and achieve better surgical outcomes than traditional procedures with regard to postoperative complications, knee function and without requiring a second operation. This technique is an effective operation method for the treatment of inferior patellar pole fractures. The study demonstrates that AS is an easily executed surgical procedure that can significantly reduce incision length and achieve better surgical outcomes compared to the traditional technique with regard to postoperative complications, knee function and without the need for a second operation.

Background Krackow suturing and suture bridge technique was compared with Kirschner-Wire (K-wire) tension band and patella cerclage for the fixation of inferior pole patella fracture. Methods This was a retrospective study of 47 patients with inferior pole patella fractures who underwent fixation procedures at our hospital between January 2019 and May 2022, of whom 25 had Krackow suturing combined with the suture-bridge technique (GROUP 1), and 22 received a K-wire tension band combined with patellar cerclage (GROUP 2). We compared the operative time, reoperation rate, Böstman score, knee range of motion (ROM), fracture-healing time, Insall–Salvati index, complications and hospital expenses between the two groups. Results The average follow-up period was 23.1 ± 5.8 months. The complication and reoperation rates in the GROUP 2 were significantly higher than those in the GROUP 1 ( P  = 0.023 and P  < 0.001). While the GROUP 1 has lower hospital expenses than GROUP 2 ( P  < 0.001). However, significant differences were not found regarding the Böstman score, knee ROM, Insall–Salvati index, fracture-healing time, and operation time between the two groups. Conclusions Both Krackow suturing combined with the suture-bridge technique and the K-wire tension band technique can achieve comparable clinical efficacy in stably fixing inferior patellar pole fractures, subsequently allowing an early commencement of rehabilitation exercise, while the suture-bridge technique can also reduce the incidence of complications, hospital expenses and the need for reoperation surgery. Trial registration This study was registered on https://www.chictr.org.cn (registration No. ChiCTR2300072069, 2023/06/01, retrospectively registered). Informed consent was obtained from all individual participants included in the study.

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.

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. Most inferior patellar pole fractures are comminuted, so it is difficult to achieve anatomical reduction and strong fixation. As a result, many investigators have proposed different surgical techniques and devices to treat inferior patellar pole fractures, such as partial patellectomy, screw fixation with a titanium cable or steel wire, interwoven sutures and basket plates, mesh plates, angle‐stable locking plates, wire interwoven sutures and Krachow sutures, and separate vertical wiring (SVW). The modified tension band fixation technique (Krachow suturing with Nice knots combined with tension band fixation) 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.

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.

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.

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.

Background Although non-surgical and surgical approaches have been developed to repair acute closed Achilles tendon ruptures, the medical community still lacks a definitive consensus on which approach is superior. This study describes a new minimally invasive internal splinting technique combined with knotless anchors for the treatment of 22 patients with acute closed Achilles tendon rupture. Methods A retrospective study was conducted involving 22 patients with acute closed Achilles tendon rupture who were treated with a minimally invasive internal splinting technique at Jingzhou Hospital of Yangtze University between January 2022 to October 2023. The study recorded and compared various metrics, including the Visual analogue scale (VAS), American Orthopedic Foot and Ankle Society (AOFAS), Achilles tendon total rupture score (ATRS), and range of motion (ROM) of the plantar-flexor-extensor foot, both preoperatively and at the final follow-up. Results We bridged the intact portion of the Achilles tendon proximal to the rupture site and the calcaneal bone using a Krackow locking loop suture technique and a knotless anchor staple technique. Twenty-two patients were monitored over a period from 10 to 12 months, with an average follow-up duration of (11.6 ± 0.67) months. At the last follow-up, all patients had successfully resumed their sports activities and work without experiencing any complications, such as Achilles tendon rupture, postoperative infection, and peroneal nerve injury. The VAS score postoperatively was recorded at (0.14 ± 0.35), representing a significant reduction from the preoperative score of (4.05 ± 0.58). The AOFAS-AH score improved to (97.41 ± 4.00), a notable increase compared to the preoperative score (52.82 ± 4.43). Similarly, the ATRS score reached (98.23 ± 2.98), also significantly higher than the preoperative score (56.95 ± 4.62). Furthermore, the range of motion (ROM) was measured at (44.27 ± 1.08), significantly surpassing the preoperative value of (26.91 ± 2.09), with all differences being statistically significant ( p  < 0.05). Conclusion The procedure is simple. Two small incisions are placed over the intact proximal Achilles tendon and the calcaneus without surgical invasion of the rupture site, which promotes the natural repair of the ruptured Achilles tendon. The intact proximal Achilles tendon and the calcaneus are securely bridged with high-strength sutures and knotless anchors, reducing complications and promoting healing of the Achilles tendon.

Quadriceps tendon rupture is uncommon and often overlooked in emergency. Tearing affects weakening tendon by systemic diseases or some medications. The mechanism is generally indirect. Inability to actively extend the knee associated to a supra-patellar defect evoke easily the diagnosis without other investigations. Surgical repair is realized in emergency to completely restore the extension. We report a case of a patient who has sustained of complete quadriceps tendon tear after a long period of tendon weakening by statin therapy, hypertension and diabetes. The repair has consisted on end-to-end Krackow sutures associated with bone suture to the proximal pole of the patella. Surgeons and emergency physicians must think to this form of extensor apparatus rupture, because early diagnosis leads to early treatment and to best outcomes.

PurposeTo evaluate the feasibility and clinical effect of Krackow suturing combined with the suture bridge technique for the treatment of acute inferior pole patella fracture.MethodsIn this study, 18 patients with acute inferior pole patella fracture who received treatment using Krackow suturing combined with the suture bridge technique between January 2019 and March 2020 were retrospectively reviewed. There were 10 men and 8 women, with an average age of 50.1 years (range 24–69 years). X-ray examinations were performed to assess fracture healing and the Insall–Salvati index. The clinical effect was measured by the range of motion of the knee joint and the Böstman scale.ResultsPatients were followed up for 13–26 months, with an average follow-up period of 19.6 months. X-ray indicated that fracture union had occurred in all patients by 10.1 weeks after surgery on average (range 8–14 weeks). The mean Insall–Salvati index immediately after surgery and at the final follow-up was 0.98 ± 0.07 and 0.90 ± 0.22, respectively (P > 0.05). At the last follow-up, the mean flexion and extension ranges for the knee joint were 135.8° ± 8.8° and − 2.8° ± 3.9°, respectively, and the mean Böstman scale was 28.9 ± 1.1 points. Functional recovery was excellent in 17 patients and good in one patient, resulting in an overall good/excellent recovery rate of 100%.ConclusionsOur results indicated that Krackow suturing combined with the suture bridge technique can achieve stable fracture fixation, provides good clinical outcomes in the treatment of acute inferior pole patella fracture, and is worthy of clinical application.