{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T11:15:08Z","timestamp":1783509308917,"version":"3.55.0"},"reference-count":27,"publisher":"MDPI AG","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:p>\n                    <jats:bold>Background:<\/jats:bold>\n                    The ideal suture technique and type in tendon repair remain unclear. This biomechanical study aimed to assess the biomechanical characteristics of three techniques\u2014modified Kessler (mKE), modified Krackow (mKR), and modified tension Bunnell (mtBU)\u2014in sheep Achilles tendon tear repair using three suture types\u2014polypropylene, polyester, and ultra-high-molecular-weight polyethylene (UHMWPE)\u2014which are also compared.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Methods:<\/jats:bold>\n                    Sixty-three Achilles tendons harvested from sheep were transversely hacked as a replacement for rupture in a standardized measure and repaired using mKE, mKR, and mtBU techniques with No. 2 polypropylene, polyester, and UHMWPE sutures. Biomechanical parameters, such as Young\u2019s modulus, ultimate strength, and strength to the 5-mm gap, were recorded for statistical analysis.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Results:<\/jats:bold>\n                    The mtBU technique with UHMWPE use resulted in increased ultimate strength, strength to 5-mm gap, Young\u2019s modulus, and quantity of specimens with low clinical failure modes compared with the other techniques with other suture materials. Furthermore, mtBU has the lowest thickness at the repair side of the tendons. This approach showed tendon failure during maximal traction testing, whereas the mKE and mKR techniques had polyethylene and polyester suture failures.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusions:<\/jats:bold>\n                    The UHMWPE suture was significantly superior to the other sutures in each technique in terms of strength and durability. The mtBU technique using UHMWPE suture showed better biomechanical results, implying that this repair might be more appropriate to obtain early mobilization after tendon ruptures.\n                  <\/jats:p>","DOI":"10.7547\/21-136","type":"journal-article","created":{"date-parts":[[2022,10,17]],"date-time":"2022-10-17T13:18:40Z","timestamp":1666012720000},"source":"Crossref","is-referenced-by-count":6,"title":["Comparison of Suture Types and Techniques in Achilles Tendon Repair: An Ex Vivo Biomechanical Animal Experiment"],"prefix":"10.3390","volume":"114","author":[{"given":"Fatih","family":"Dogar","sequence":"first","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Kahramanmaras Sutcu Imam University Medical Faculty, Kahramanmaras, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaan","family":"Gurbuz","sequence":"additional","affiliation":[{"name":"Clinical Orthopedics and Traumatology, Kayseri City Education and Research Hospital, Kayseri, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Duran","family":"Topak","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Kahramanmaras Sutcu Imam University Medical Faculty, Kahramanmaras, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mustafa Abdullah","family":"Ozdemir","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Kahramanmaras Sutcu Imam University Medical Faculty, Kahramanmaras, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Burak","family":"Ku\u015f\u00e7u","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Kahramanmaras Sutcu Imam University Medical Faculty, Kahramanmaras, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yakup","family":"Ekinci","sequence":"additional","affiliation":[{"name":"Clinical Orthopedics and Traumatology, Kayseri City Education and Research Hospital, Kayseri, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabri","family":"Batin","sequence":"additional","affiliation":[{"name":"Clinical Orthopedics and Traumatology, Kayseri City Education and Research Hospital, Kayseri, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hakan","family":"Yaykasli","sequence":"additional","affiliation":[{"name":"Department of Electronics, Elbistan Vocational School of Higher Education, Kahramanmaras Istiklal University, Kahramanmaras, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Okkes","family":"Bilal","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Kahramanmaras Sutcu Imam University Medical Faculty, Kahramanmaras, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","reference":[{"key":"B1","series-title":"Am J Sports Med","first-page":"565","article-title":"Quantitative review of operative and nonoperative management of Achilles tendon ruptures","volume":"30","author":"Wong J","year":"2002","unstructured":"Wong J, Barrass V, Maffulli N: Quantitative review of operative and nonoperative management of Achilles tendon ruptures. Am J Sports Med 30: 565, 2002."},{"key":"B2","series-title":"Br Med Bull","first-page":"45","article-title":"Minimally invasive versus open surgery for acute Achilles\u2019 tendon rupture: a systematic review","volume":"109","author":"Del Buono A","year":"2014","unstructured":"Del Buono A, Volpin A, Maffulli N: Minimally invasive versus open surgery for acute Achilles\u2019 tendon rupture: a systematic review. Br Med Bull 109: 45, 2014."},{"key":"B3","series-title":"J Bone Joint Surg Br","first-page":"663","article-title":"Biomechanical comparison of four methods of repair of the Achilles tendon: a laboratory study with bovine tendons","volume":"94","author":"Ortiz C","year":"2012","unstructured":"Ortiz C, Wagner E, Moco\u00e7ain P, et al: Biomechanical comparison of four methods of repair of the Achilles tendon: a laboratory study with bovine tendons. J Bone Joint Surg Br 94: 663, 2012."},{"key":"B4","series-title":"J Orthop Surg Res","first-page":"72,","article-title":"Suture material for flexor tendon repair: 3-0 V-Loc versus 3-0 Stratafix in a biomechanical comparison ex vivo","volume":"9","author":"Jordan MC","year":"2014","unstructured":"Jordan MC, H\u00f6lscher-Doht S, Jakubietz MG, et al: Suture material for flexor tendon repair: 3-0 V-Loc versus 3-0 Stratafix in a biomechanical comparison ex vivo. J Orthop Surg Res 9: 72, 2014."},{"key":"B5","series-title":"PLoS One","first-page":"e0243306","article-title":"Comparison of the double loop knot stitch and Kessler stitch for Achilles\u2019 tendon repair: a biomechanical cadaver study","volume":"15","author":"Frosch S","year":"2020","unstructured":"Frosch S, Buchhorn G, Hawellek T, et al: Comparison of the double loop knot stitch and Kessler stitch for Achilles\u2019 tendon repair: a biomechanical cadaver study. PLoS One 15: e0243306, 2020."},{"key":"B6","series-title":"J Foot Ankle Surg","first-page":"86","article-title":"Biomechanical study of a multifilament stainless steel cable crimp system versus a multistrand ultra-high molecular weight polyethylene polyester suture Krackow technique for Achilles\u2019 tendon rupture repair","volume":"59","author":"Nguyen TP","year":"2020","unstructured":"Nguyen TP, Keyt LK, Herfat S, et al: Biomechanical study of a multifilament stainless steel cable crimp system versus a multistrand ultra-high molecular weight polyethylene polyester suture Krackow technique for Achilles\u2019 tendon rupture repair. J Foot Ankle Surg 59: 86, 2020."},{"key":"B7","series-title":"J Biomed Mater Res","first-page":"1544","article-title":"Suture materials: current and emerging trends","volume":"104","author":"Dennis C","year":"2016","unstructured":"Dennis C, Sethu S, Nayak S, et al: Suture materials: current and emerging trends. J Biomed Mater Res 104: 1544, 2016."},{"key":"B8","series-title":"Foot Ankle Surg","first-page":"280","article-title":"Surgical versus non-surgical treatment for acute Achilles\u2019 tendon rupture. a systematic review of literature and meta-analysis","volume":"26","author":"Reda Y","year":"2020","unstructured":"Reda Y, Farouk A, Abdelmonem I, et al: Surgical versus non-surgical treatment for acute Achilles\u2019 tendon rupture. a systematic review of literature and meta-analysis. Foot Ankle Surg 26: 280, 2020."},{"key":"B9","series-title":"J Clin Med Res","first-page":"573","article-title":"Chronic Achilles tendon rupture reconstruction using the Lindholm method and the Vulpius method","volume":"9","author":"Ozan F","year":"2017","unstructured":"Ozan F, Dogar F, Gurbuz K, et al: Chronic Achilles tendon rupture reconstruction using the Lindholm method and the Vulpius method. J Clin Med Res 9: 573, 2017."},{"key":"B10","series-title":"Am J Sports Med","first-page":"3728","article-title":"Treatment of acute Achilles\u2019 tendon ruptures: a systematic review and meta-analysis of complication rates with best- and worst-case analyses for rerupture rates","volume":"49","author":"Seow D","year":"2021","unstructured":"Seow D, Yasui Y, Calder JD, et al: Treatment of acute Achilles\u2019 tendon ruptures: a systematic review and meta-analysis of complication rates with best- and worst-case analyses for rerupture rates. Am J Sports Med 49: 3728, 2021."},{"key":"B11","series-title":"Text Res J","first-page":"2123","article-title":"Polycaprolactone\/ultra-high molecular weight polyethylene partially absorbable suture with improved mechanical performances for tendon and ligament repair","volume":"90","author":"Zhang Q","year":"2020","unstructured":"Zhang Q, Li C, Luan J, et al: Polycaprolactone\/ultra-high molecular weight polyethylene partially absorbable suture with improved mechanical performances for tendon and ligament repair. Text Res J 90: 2123, 2020."},{"key":"B12","series-title":"PLoS One","article-title":"Whether sutures reduce the graft laceration caused by interference screw in anterior cruciate ligament reconstruction a biomechanical study in vitro","author":"Teng Y","year":"2021","unstructured":"Teng Y, Da L, Zhang X, et al: Whether sutures reduce the graft laceration caused by interference screw in anterior cruciate ligament reconstruction a biomechanical study in vitro. PLoS One 2021."},{"key":"B13","series-title":"Sports Med Arthrosc Rehabil","first-page":"e263","article-title":"The clinical and biomechanical performance of all-suture anchors: a systematic review","volume":"2","author":"Erg\u00fcn S","year":"2020","unstructured":"Erg\u00fcn S, Akg\u00fcn U, Barber FA, et al: The clinical and biomechanical performance of all-suture anchors: a systematic review. Sports Med Arthrosc Rehabil 2: e263, 2020."},{"key":"B14","series-title":"Arch Orthop Trauma Surg","first-page":"1775","article-title":"A biomechanical comparison of Achilles tendon suture repair techniques: locking block modified Krackow, Kessler, and percutaneous Achilles repair system with the early rehabilitation program in vitro bovine model","volume":"140","author":"Tian J","year":"2020","unstructured":"Tian J, Rui Y, Xu Y, et al: A biomechanical comparison of Achilles tendon suture repair techniques: locking block modified Krackow, Kessler, and percutaneous Achilles repair system with the early rehabilitation program in vitro bovine model. Arch Orthop Trauma Surg 140: 1775, 2020."},{"key":"B15","series-title":"Foot Ankle Int","first-page":"1074","article-title":"Biomechanical testing of epitenon suture strength in Achilles\u2019 tendon repairs","volume":"28","author":"Shepard ME","year":"2007","unstructured":"Shepard ME, Lindsey DP, Chou LB: Biomechanical testing of epitenon suture strength in Achilles\u2019 tendon repairs. Foot Ankle Int 28: 1074, 2007."},{"key":"B16","series-title":"The Science and Engineering of Materials","first-page":"196","author":"Askeland DR","year":"2010","unstructured":"Askeland DR, Fulay PP, Wright WJ: The Science and Engineering of Materials, 6th Ed, p 196, Cengage Learning, Stamford, CT, 2010."},{"key":"B17","series-title":"J Hand Surg Eur Vol","first-page":"6","article-title":"Recent developments in flexor tendon repair techniques and factors influencing strength of the tendon repair","volume":"39","author":"Wu YF","year":"2014","unstructured":"Wu YF, Tang JB: Recent developments in flexor tendon repair techniques and factors influencing strength of the tendon repair. J Hand Surg Eur Vol 39: 6, 2014."},{"key":"B18","series-title":"Knee Surg Sports Traumatol Arthrosc","first-page":"2097","article-title":"Tendon healing: an overview of physiology, biology, and pathology of tendon healing and systematic review of state of the art in tendon bioengineering","volume":"23","author":"M\u00fcller SA","year":"2015","unstructured":"M\u00fcller SA, Todorov A, Heisterbach PE, et al: Tendon healing: an overview of physiology, biology, and pathology of tendon healing and systematic review of state of the art in tendon bioengineering. Knee Surg Sports Traumatol Arthrosc 23: 2097, 2015."},{"key":"B19","series-title":"Plast Reconstr Surg","first-page":"e237","article-title":"A barbed suture repair for flexor tendons: a novel technique with no exposed barbs","volume":"2","author":"Joyce CW","year":"2014","unstructured":"Joyce CW, Sugrue C, Chan JC, et al: A barbed suture repair for flexor tendons: a novel technique with no exposed barbs. Plast Reconstr Surg 2: e237, 2014."},{"key":"B20","series-title":"J Orthop Traumatol","first-page":"251","article-title":"Barbed suture vs conventional tenorrhaphy: biomechanical analysis in an animal model","volume":"16","author":"Clemente A","year":"2015","unstructured":"Clemente A, Bergamin F, Surace C, et al: Barbed suture vs conventional tenorrhaphy: biomechanical analysis in an animal model. J Orthop Traumatol 16: 251, 2015."},{"key":"B21","series-title":"Hand","first-page":"6","article-title":"Barbed sutures and tendon repair: a review","volume":"10","author":"Shah A","year":"2015","unstructured":"Shah A, Rowlands M, Au A: Barbed sutures and tendon repair: a review. Hand 10: 6, 2015."},{"key":"B22","series-title":"J Foot Ankle Surg","first-page":"1191","article-title":"Surgical versus non-surgical methods for acute Achilles tendon rupture: a meta-analysis of randomized controlled trials","volume":"57","author":"Zhou K","year":"2018","unstructured":"Zhou K, Song L, Zhang P, et al: Surgical versus non-surgical methods for acute Achilles tendon rupture: a meta-analysis of randomized controlled trials. J Foot Ankle Surg 57: 1191, 2018."},{"key":"B23","series-title":"Am J Sports Med","first-page":"1767","article-title":"Augmented versus nonaugmented repair of acute Achilles tendon rupture: a systematic review and meta-analysis","volume":"46","author":"Zhang YJ","year":"2018","unstructured":"Zhang YJ, Zhang C, Wang Q, et al: Augmented versus nonaugmented repair of acute Achilles tendon rupture: a systematic review and meta-analysis. Am J Sports Med 46: 1767, 2018."},{"key":"B24","series-title":"Foot Ankle Int","first-page":"701","article-title":"The strength of Achilles tendon repair: a comparison of three suture techniques in human cadaver tendons","volume":"31","author":"McCoy BW","year":"2010","unstructured":"McCoy BW, Haddad SL: The strength of Achilles tendon repair: a comparison of three suture techniques in human cadaver tendons. Foot Ankle Int 31: 701, 2010."},{"key":"B25","series-title":"Arthroscopy","first-page":"3001","article-title":"The biomechanical performance of the latest all-inside meniscal repair devices","volume":"36","author":"Barber FA","year":"2020","unstructured":"Barber FA, Howard MS, Ashraf W, et al: The biomechanical performance of the latest all-inside meniscal repair devices. Arthroscopy 36: 3001, 2020."},{"key":"B26","series-title":"Arthroscopy","first-page":"2805","article-title":"Cyclic and load-to-failure properties of all-suture anchors in human cadaveric shoulder greater tuberosities","volume":"36","author":"Trofa DP","year":"2020","unstructured":"Trofa DP, Ruder JA, Yeatts NC, et al: Cyclic and load-to-failure properties of all-suture anchors in human cadaveric shoulder greater tuberosities. Arthroscopy 36: 2805, 2020."},{"key":"B27","series-title":"J Bone Joint Surg Br","first-page":"69","article-title":"Randomised controlled trials of immediate weight-bearing mobilization for rupture of the tendo Achillis","volume":"88","author":"Costa ML","year":"2006","unstructured":"Costa ML, MacMillan K, Halliday D, et al: Randomised controlled trials of immediate weight-bearing mobilization for rupture of the tendo Achillis. J Bone Joint Surg Br 88: 69, 2006."}],"container-title":["Journal of the American Podiatric Medical Association"],"original-title":[],"link":[{"URL":"https:\/\/japmaonline.org\/view\/journals\/apms\/114\/2\/21-136.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/japmaonline.org\/downloadpdf\/journals\/apms\/114\/2\/21-136.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/japmaonline.org\/downloadpdf\/journals\/apms\/114\/2\/21-136.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T10:19:35Z","timestamp":1783505975000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1930-8264\/114\/2\/21136"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3]]},"references-count":27,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.7547\/21-136","relation":{},"ISSN":["8750-7315"],"issn-type":[{"value":"8750-7315","type":"print"}],"subject":[],"published":{"date-parts":[[2024,3]]}}}