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Evaluation of a New Knotless Suture Anchor Repair in Acute Achilles Tendon Ruptures: A Biomechanical Comparison of Three Techniques

      Abstract

      Acute ruptures of the Achilles tendon are a common injury, and debate has continued in published studies on how best to treat these injuries. Specifically, controversy exists regarding the surgical approaches for Achilles tendon repair when one considers percutaneous versus open repair. The present study investigated the biomechanical strength of 3 different techniques for Achilles tendon repair in a cadaveric model. A total of 36 specimens were divided into 3 groups, each of which received a different construct. The first group received a traditional Krackow suture repair, the second group was repaired using a jig-assisted percutaneous suture, and the third group received a repair using a jig-assisted percutaneous repair modified with suture anchors placed into the calcaneus. The specimens were tested with cyclical loading and to ultimate failure. Cyclical loading showed a trend toward a stronger repair with the use of suture anchors after 10 cycles (p = .295), 500 cycles (p = .120), and 1000 cycles (p = .040). The ultimate load to failure was greatest in the group repaired with the modified knotless technique using the suture anchors (p = .098). The results of the present study show a clear trend toward a stronger construct in Achilles repair using a knotless suture anchor technique, which might translate to a faster return to activity and be more resistant to an early and aggressive rehabilitation protocol. Further clinical studies are warranted to evaluate this technique in a patient population.

      Level of Clinical Evidence

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      References

        • Ding W.-G.
        • Li H.
        • Zhu Y.P.
        • Liu Z.W.
        Comparison between tenocutaneous suture and Kessler suture techniques in treating acute closed Achilles' tendon rupture.
        Foot Ankle Surg. 2014; 20: 105-108
        • Jozsa L.
        • Kvist M.
        • Bálint B.J.
        • Reffy A.
        • Järvinen M.
        • Lehto M.
        • Barzo M.
        The role of recreational sport activity in Achilles' tendon rupture: a clinical, pathoanatomical, and sociological study of 292 cases.
        Am J Sports Med. 1989; 17: 338-343
        • Keating J.F.
        • Will E.M.
        Operative versus non-operative treatment of acute rupture of tendo-Achilles.
        J Bone Joint Surg Br. 2011; 93: 1071-1078
        • Fitzgibbons R.E.
        • Hefferon J.
        • Hill J.
        Percutaneous Achilles tendon repair.
        Am J Sports Med. 1993; 21: 724-727
        • Lim J.
        • Dalal R.
        • Waseem M.
        Percutaneous vs. open repair of the ruptured Achilles tendon: a prospective randomized controlled study.
        Foot Ankle Int. 2001; 22: 559-568
        • Gorchewsky O.
        • Pitzl M.
        • Putz A.
        • Klakow A.
        • Neumann W.
        Percutaneous repair of acute Achilles tendon rupture.
        Foot Ankle Int. 2004; 25: 219-224
        • Aktas S.
        • Kocaoglu B.
        Open versus minimal invasive repair with Achillon device.
        Foot Ankle Int. 2009; 30: 391-397
        • Haji A.
        • Sahai A.
        • Symes A.
        • Vyas J.K.
        Percutaneous versus open tendo-Achilles repair.
        Foot Ankle Int. 2011; 32: 879-887
        • Henriquez H.
        • Muñoz R.
        • Carcuro G.
        • Bastías C.
        Is percutaneous repair better than open repair in acute Achilles tendon rupture?.
        Clin Orthop Relat Res. 2012; 470: 998-1003
        • Huffard B.
        • O’Laughlin P.F.
        • Wright T.
        • Deland J.
        • Kennedy J.G.
        Achilles tendon repair: Achillon system vs. Krackow suture: an anatomic in vitro biomechanical study.
        Clin Biomech. 2008; 23: 1158-1164
        • Demetracopoulos C.A.
        • Gilbert S.L.
        • Young E.
        • Baxter J.R.
        • Deland J.T.
        Limited-open Achilles tendon repair using locking sutures versus nonlocking sutures: an in vitro model.
        Foot Ankle Int. 2014; 35: 612-618
        • Kangas J.
        • Pajala A.
        • Ohtonen P.
        • Leppilahti J.
        Achilles tendon elongation after rupture repair: a randomized comparison of 2 postoperative regimens.
        Am J Sports Med. 2007; 35: 59-65
        • Mendelbaum B.R.
        • Myerson M.S.
        • Forster R.
        Achilles tendon ruptures: a new method of repair, early range of motion, and functional rehabilitation.
        Am J Sports Med. 1995; 23: 392-395
        • Mortensen H.M.
        • Skov O.
        • Jensen P.E.
        Early motion of the ankle after operative treatment of a rupture of the Achilles tendon: a prospective, randomized clinical and radiographic study.
        J Bone Joint Surg Am. 1999; 81: 983-990
        • Solveborn S.A.
        • Moberg A.
        Immediate free ankle motion after surgical repair of acute Achilles tendon ruptures.
        Am J Sports Med. 1994; 22: 607-610
        • Suchak A.A.
        • Bostick G.P.
        • Beaupre L.A.
        The influence of early weight-bearing compared with non-weight-bearing after surgical repair of the Achilles tendon.
        J Bone Joint Surg Am. 2008; 90: 1876-1883
        • Mortensen N.H.
        • Saether J.
        • Steinke M.S.
        • Staer H.
        • Mikkelsen S.S.
        Separation of tendon ends after Achilles tendon repair: a prospective, randomized, multicenter study.
        Orthopedics. 1992; 15: 899-903
        • Nystrom B.
        • Holmlund D.
        Separation of tendon ends after suture of Achilles tendon.
        Acta Orthop Scand. 1983; 54: 620-621
        • Lee S.J.
        • Goldsmith S.
        • Nicholas S.J.
        • McHugh M.
        Optimizing Achilles tendon repair: effect of epitendinous suture augmentation the strength of Achilles tendon repairs.
        Foot Ankle Int. 2008; 29: 427-432
        • Shepard M.E.
        • Lindsey D.P.
        • Chou L.B.
        Biomechanical comparison of the simple running and cross-stitch epitenon sutures in Achilles tendon repairs.
        Foot Ankle Int. 2008; 29: 513-517
        • Kanz B.N.
        • Morris R.P.
        • Lewis T.
        • Panchbhavi V.K.
        Biomechanical evaluation of a knotless barbed suture repair in a human Achilles tendon rupture model.
        Foot Ankle Spec. 2014; 7: 176-181