Advertisement

Achilles Tendon Open Surgical Treatment With Platelet-Rich Fibrin Matrix Augmentation: Biomechanical Evaluation

      Abstract

      The relationship between surgical technique and ankle biomechanical properties after surgery for acute rupture of the Achilles tendon (ATR) has not yet been fully investigated. Platelet-rich fibrin (PRF) matrices seem to play a central role in the complex processes of tendon healing. Our aim was to analyze the biomechanical characteristics, stiffness, and mechanical work of the ankle during walking in patients who had undergone surgery after ATR with and without PRF augmentation. We performed a retrospective review of all consecutive patients who had been treated with surgical repair after ATR. Of the 20 male subjects enrolled, 9 (45%) had undergone conventional open repair of the Achilles tendon using the Krackow technique (no-PRF) and 11 (55%) had undergone surgery with PRF augmentation. An additional 8 healthy subjects were included as a control group. A gait analysis evaluation was performed at 6 months after surgery. The percentage of the stance time of the operated leg, double-support time of the healthy leg, and net work of the ankle during the gait cycle showed statistically significant differences between the no-PRF and the healthy group (p < .005). No differences were found between the PRF and healthy groups. Treatment with suture and PRF augmentation could result in significant functional improvements in term of efficiency of motion.

      Level of Clinical Evidence

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The Journal of Foot and Ankle Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Holm C.
        • Kjaer M.
        • Eliasson P.
        Achilles tendon rupture treatment and complications: a systematic review.
        Scand J Med Sci Sports. 2015; 25: e1-e10
        • Cho N.S.
        • Hwang J.H.
        • Lee Y.T.
        • Chae S.W.
        Tendinosis-like histologic and molecular changes of the Achilles tendon to repetitive stress: a pilot study in rats.
        Clin Orthop Relat Res. 2011; 469: 3172-3180
        • Doral M.N.
        • Alam M.
        • Bozkurt M.
        • Turhan E.
        • Atay O.A.
        • Dönmez G.
        • Maffulli N.
        Functional anatomy of the Achilles tendon.
        Knee Surg Sports Traumatol Arthrosc. 2010; 18: 638-643
        • Lantto I.
        • Heikkinen J.
        • Flinkkilä T.
        • Ohtonen P.
        • Leppilahti J.
        Epidemiology of Achilles tendon ruptures: increasing incidence over a 33-year period.
        Scand J Med Sci Sports. 2014; 25: e133-e138
        • Wilkins R.
        • Bisson L.J.
        Operative versus non operative management of acute Achilles tendon ruptures: a quantitative systematic review of randomized controlled trials.
        Am J Sports Med. 2012; 40: 2154-2160
        • Maffulli N.
        • Spiezia F.
        • Longo U.G.
        • Denaro V.
        Z-shortening of healed, elongated Achilles tendon rupture.
        Int Orthop. 2012; 36: 2087-2093
        • Jiang N.
        • Wang B.
        • Chen A.
        • Dong F.
        • Yu B.
        Operative versus non operative treatment for acute Achilles tendon rupture: a meta-analysis based on current evidence.
        Int Orthop. 2012; 36: 765-773
        • Khan R.J.
        • Carey Smith R.L.
        Surgical interventions for treating acute Achilles tendon ruptures.
        Cochrane Database Syst Rev. 2010; 9: CD003674
        • McMahon S.E.
        • Smith T.O.
        • Hing C.B.
        A meta-analysis of randomised controlled trials comparing conventional to minimally invasive approaches for repair of an Achilles tendon rupture.
        Foot Ankle Surg. 2011; 17: 211-217
        • Anitua E.
        • Sanchez M.
        • Nurden A.T.
        • Zalduendo M.
        • de la Fuente M.
        • Orive G.
        • Azofra J.
        • Andia I.
        Autologous fibrin matrices: a potential source of biological mediators that modulate tendon cell activities.
        J Biomed Mater Res A. 2006; 77: 285-293
        • Antuña S.
        • Barco R.
        • Martínez Diez J.M.
        • Sánchez Márquez J.M.
        Platelet-rich fibrin in arthroscopic repair of massive rotator cuff tears: a prospective randomized pilot clinical trial.
        Acta Orthop Belg. 2013; 79: 25-30
        • Dietrich F.
        • Duré G.L.
        • Klein C.P.
        • Bampi V.F.
        • Padoin A.V.
        • Silva V.D.
        • Braga-Silva J.
        Platelet-rich fibrin promotes an accelerated healing of Achilles tendon when compared to platelet-rich plasma in rat.
        World J Plast Surg. 2015; 4: 101-109
        • Carter C.A.
        • Jolly D.G.
        • Worden C.E.
        • Hendren D.G.
        • Kane C.J.M.
        Platelet rich plasma gel promotes differentiation and regeneration during equine wound healing.
        Exp Mol Pathol. 2003; 74: 244-255
        • Bruggeman N.B.
        • Turner N.S.
        • Dahm D.L.
        • Voll A.E.
        • Hoskin T.L.
        • Jacofsky D.J.
        • Haidukewych G.J.
        Wound complications after open Achilles tendon repair.
        Clin Orthop Relat Res. 2004; 427: 63-66
        • Khan R.J.
        • Fick D.
        • Brammar T.J.
        • Crawford J.
        • Parker M.J.
        Interventions for treating Achilles tendon ruptures.
        Cochrane Database Syst Rev. 2005; 2: 1-54
        • Sánchez M.
        • Anitua E.
        • Azofra J.
        • Andía I.
        • Padilla S.
        • Mujika I.
        Comparison of surgically repaired Achilles tendon tears using platelet-rich fibrin matrices.
        Am J Sports Med. 2007; 35: 245-251
        • Chan B.P.
        • Fu S.C.
        • Qin L.
        • Lee K.M.
        • Rolf C.G.
        • Chan K.M.
        Effects of basic fibroblast growth factor (bFGF) on early stages of tendon healing:a rat patellar tendon model.
        Acta Orthop Scand. 2000; 71: 513-518
        • Kurtz C.A.
        • Loebig T.G.
        • Anderson D.D.
        • Demeo P.J.
        • Campbell P.G.
        Insulin like growth factor I accelerates functional recovery from Achilles tendon injury in a rat model.
        Am J Sports Med. 1999; 27: 363-369
        • Molloy T.
        • Wang Y.
        • Murrell G.A.C.
        The roles of growth factors in tendon and ligament healing.
        Sports Med. 2003; 33: 381-394
        • Yoshikawa Y.
        • Abrahamsson O.
        Dose-related cellular effects of platelet-derived growth factor-BB differ in various types of rabbit tendons in vitro.
        Acta Orthop Scand. 2001; 72: 287-292
        • Hsu C.H.
        • Chang J.
        Clinical implications of growth factors in flexor tendon wound healing.
        J Hand Surg Am. 2004; 29: 551-563
        • Weber S.C.
        • Kauffman J.I.
        • Parise C.
        • Weber S.J.
        • Katz S.D.
        Platelet-rich fibrin matrix in the management of arthroscopic repair of the rotator cuff: a prospective, randomized, double-blinded study.
        Am J Sports Med. 2013; 41: 263-270
        • Rodeo S.A.
        • Delos D.
        • Williams R.J.
        • Adler R.S.
        • Pearle A.
        • Warren R.F.
        The effect of platelet-rich fibrin matrix on rotator cuff tendon healing: a prospective, randomized clinical study.
        Am J Sports Med. 2012; 40: 1234-1241
        • Don R.
        • Ranavolo A.
        • Cacchio A.
        • Serrao M.
        • Costabile F.
        • Iachelli M.
        • Camerota F.
        • Frascarelli M.
        • Santilli V.
        Relationship between recovery of calf-muscle biomechanical properties and gait pattern following surgery for Achilles tendon rupture.
        Clin Biomech. 2007; 22: 211-220
        • Krackow K.A.
        • Thomas S.C.
        • Jones L.C.
        Ligament-tendon fixation: analysis of a new stitch and comparison with standard techniques.
        Orthopedics. 1988; 11: 909-917
        • Davis R.B.
        • De Luca P.A.
        Gait characterization via dynamic joint stiffness.
        Gait Posture. 1996; 4: 224-231
        • Frigo C.
        • Crenna P.
        • Jensen L.M.
        Moment-angle relationship at lower limb joints during human walking at different velocities.
        J Electromyogr Kinesiol. 1996; 6: 177-190
        • Crenna P.
        • Frigo C.
        Dynamics of the ankle joint analyzed through moment-angle loops during human walking: gender and age effects.
        Hum Movement Sci. 2011; 30: 1185-1198
        • Shamaei K.
        • Sawicki S.G.
        • Dollar A.M.
        Estimation of quasi-stiffness and propulsive work of the human ankle in the stance phase of walking.
        PloS One. 2013; 8: e81841
        • Chan A.P.
        • Chan Y.Y.
        • Fong D.T.
        • Wong P.Y.
        • Lam H.Y.
        • Lo C.K.
        • Yung P.S.
        • Fung K.Y.
        • Chan K.M.
        Clinical and biomechanical outcome of minimal invasive and open repair of the Achilles tendon.
        Sports Med Arthrosc Rehabil Ther Technol. 2011; 3: 32
        • Longo U.G.
        • Forriol F.
        • Campi S.
        • Maffulli N.
        • Denaro V.
        A biomechanical comparison of the primary stability of two minimally invasive techniques for repair of ruptured Achilles tendon.
        Knee Surg Sports Traumatol Arthrosc. 2012; 20: 1392-1397
        • Ishikawa M.
        • Komi P.V.
        • Grey M.J.
        • Lepola V.
        • Bruggemann G.P.
        Muscle-tendon interaction and elastic energy usage in human walking.
        J Appl Physiol. 2005; 99: 603-608
        • Fukunaga T.
        • Kubo K.
        • Kawakami Y.
        • Fukashiro S.
        • Kanehisa H.
        • Maganaris C.N.
        In vivo behavior of human muscle tendon during walking.
        Proc Biol Sci. 2001; 268: 229-233
        • Lichtwark G.A.
        • Wilson A.M.
        Is Achilles tendon compliance optimized for maximum muscle efficiency during locomotion.
        J Biomech. 2005; 40: 1768-1775
        • Lichtwark G.A.
        • Bougouliasa K.
        • Wilson A.M.
        Muscle fascicle and series elastic element length changes along the length of the human gastrocnemius during walking and running.
        J Biomech. 2005; 40: 157-164
        • Kubo K.
        • Kanehisa H.
        • Takeshita D.
        • Kawakami Y.
        • Fukashiro S.
        • Fukunaga T.
        In vivo dynamics of human medial gastrocnemius muscle-tendon complex during stretch shortening cycle exercise.
        Acta Physiol Scand. 2000; 170: 127-135
        • Voigt M.
        • Bojsen-Moller F.
        • Simonsen E.B.
        • Dyhre-Poulsen P.
        The influence of tendon Youngs modulus, dimensions and instantaneous moment arms on the efficiency of human movement.
        J Biomech. 1995; 28: 281-291