The "Giftbox" repair of the Achilles tendon: a modification of the Krackow technique.

BACKGROUND: The Krackow locking loop technique has been used for Achilles tendon repair with documented success in allowing early range of motion with stable fixation. Previous studies documented failure at the rupture site by knot failure. We propose a modification of the traditional Krackow technique where the knots of the suture are tied away from the rupture site (aka the Giftbox technique). We compared the tensile strength of Achilles tendons repaired using the traditional Krackow technique with those repaired using the Giftbox technique.

MATERIALS AND METHODS: Thirteen pairs of fresh frozen cadaveric Achilles tendons were harvested. An Achilles tendon rupture was created 4 cm from the calcaneal insertion. Thirteen Achilles ruptures were repaired using the traditional Krackow technique and 13 pairs were repaired using the Giftbox technique. The Achilles tendons were then tested to failure as defined as a gap of 1 cm.

RESULTS: The mean force to failure for the tendons using the Giftbox technique was 168 N, whereas the mean for the traditional Krackow technique was 81 N (p < 0.0001).

CONCLUSION: Based on our biomechanical study, Achilles tendons repaired using the Giftbox technique are more than twice as strong as those repaired using the traditional Krackow technique.

CLINICAL RELEVANCE: We recommend the Giftbox modification to minimize gap formation and improve the strength of the repair of a ruptured Achilles tendon.