Abstract
Surgery for recalcitrant insertional Achilles tendinopathy often consists of partial
or total release of the insertion site, debridement of the diseased portion of the
tendon, calcaneal ostectomy, and reattachment of the Achilles to the calcaneus. Although
single-row and double-row techniques exist for repair of the detached Achilles tendon,
biomechanical data are lacking to support one technique over the other. Based on data
extrapolated from the study of rotator cuff repairs, we hypothesized that a double-row
construct would provide superior fixation strength over a single-row repair. Eighteen
human cadaveric Achilles tendons (9 matched pairs) with attached calcanei were repaired
with single-row or double-row techniques. Specimens were mounted in a servohydraulic
materials testing machine, subjected to a preconditioning cycle, and loaded to failure.
Failure was defined as suture breakage or pullout, midsubstance tendon rupture, or anchor
pullout. Among the failures were 12 suture failures, 5 proximal-row anchor failures,
and 1 distal-row anchor failure. No midsubstance tendon ruptures or testing apparatus
failures were observed. There were no statistically significant differences in the
peak load to failure between the single-row and double-row repairs (p = .46). Similarly, no significant differences were observed with regards to mean
energy expenditure to failure (p = .069). The present study demonstrated no biomechanical advantages of the double-row
repair over a single-row repair. Despite the lack of a clear biomechanical advantage,
there may exist clinical advantages of a double-row repair, such as reduction in knot
prominence and restoration of the Achilles footprint.
Level of Clinical Evidence
Keywords
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Article info
Publication history
Published online: August 06, 2012
Footnotes
Financial Disclosure: The implants used in this investigation were donated by Arthrex, Inc., of Naples, FL.
Conflict of Interest: None reported.
Identification
Copyright
© 2012 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.
