ABSTRACT
Percutaneous Achilles tendon repairs can be performed with 2 distal fixation techniques:
knotless suture anchor repair (KL) or percutaneous end-to-end repair (ETE). There
is a paucity of literature comparing the biomechanical strength of these 2 distal
fixation techniques. The aim of this study was to compare the strength of KL and ETE
repairs using flat-braided suture for mid-substance Achilles tendon rupture during
simulated progressive rehabilitation. Nine matched pairs of fresh-frozen below-knee
cadaveric extremities were randomly assigned into these 2 repair groups. Each specimen
was tested in 2 parts sequentially; Part I simulating passive ankle range of motion
(cyclic: 20N-100N), and Part II simulating ambulation in a walking boot (cyclic: 20N-190N).
The number of cycles, gap displacement, and the mode of failure were recorded for
each repair. Achilles tendon repairs using the percutaneous methods of ETE and KL
techniques showed no significant difference in the number of cycles to clinical failure,
mean gap displacement, or overall failure rate. During Part I, the survival rate in
terms of clinical failure for KL and ETE groups was 8 of 9 repairs and 7 of 9 repairs,
respectively. During Part II, all repairs experienced clinical failure in both groups.
Five repairs in the KL group experienced suture anchor pull out from the calcaneus,
and 3 repairs failed at suture-tendon interface. Four repairs in the ETE group failed
due to knot slippage and 5 repairs failed at suture-tendon interface. Both techniques
are viable options in treating acute mid-substance Achilles tendon ruptures.
Level of Clinical Evidence
Keywords
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Article info
Publication history
Published online: April 01, 2022
Footnotes
Investigation Performed at: Sanford Health, Fargo, ND, USA.
Reprint: Alexander Chong, Phone: 701-417-6306.
Financial Disclosures: None reported.
Conflict of Interest: This study received no external support. The authors received no payment, personal benefit, commitments, or agreements related to the research. No benefits of any form were received or will be received from a commercial party directly or indirectly to this study.
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