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International Orthopaedics

, Volume 36, Issue 9, pp 1947–1951 | Cite as

Initial Achilles tendon repair strength—synthesized biomechanical data from 196 cadaver repairs

  • Patrick SadoghiEmail author
  • Claudio Rosso
  • Victor Valderrabano
  • Andreas Leithner
  • Patrick Vavken
Original Paper

Abstract

Purpose

The study aim was to describe what kind of operative technique performs best with respect to initial strength after the surgical repair of acute Achilles tendon ruptures.

Methods

We performed a systematic search of the keywords “Achilles tendon AND (suture strength OR biomechanics) AND (cadaver NOT animal)” in the online databases PubMed, EMBASE, CINAHL, and the Cochrane Library. We included studies that employed open, mini-open, or percutaneous Achilles tendon repair in human cadavers, and assessed some measure of tensile strength as a primary outcome.

Results

Our search produced 11 relevant papers reporting results for Kessler, Bunnell, and Krackow sutures in open repair, as well as the Achillon device, the Ma-Griffith repair technique, the triple bundle technique and the “giftbox” technique. The weighted tensile strengths ranged from 81 to 453 N (mean 222.7 N) with the Triple Bundle technique in combination with # 2 Ethibond performing best with a mean of 453 N.

Conclusions

Due to the small sample sizes, different study designs, and heterogeneity of strength measurement techniques, definite recommendations on surgical technique cannot be made but presented information might help in the decision making process for foot and ankle surgeons.

Keywords

Achilles Tendon Suture Material Acute Achilles Tendon Rupture Core Suture Repair Strength 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Maffulli N (1999) Rupture of the Achilles tendon. J Bone Joint Surg Am 81:1019–1036PubMedGoogle Scholar
  2. 2.
    Mafulli N, Waterson SW, Squair J, Reaper J, Douglas AS (1999) Changing incidence of Achilles tendon rupture in Scotland: a 15-year study. Clin J Sport Med 9(3):157–160CrossRefGoogle Scholar
  3. 3.
    Bhattacharyya M, Gerber B (2009) Mini-invasive surgical repair of the Achilles tendon-does it reduce post-operative morbidity? Int Orthop 33(1):151–156PubMedCrossRefGoogle Scholar
  4. 4.
    Chiara Vuliani M, Guzzini M, Ferreti A (2003) Operative treatment of chronic Achilles tendinopathy. Int Orthop 27(5):307–310CrossRefGoogle Scholar
  5. 5.
    Maffulli N (1999) Rupture of the Achilles tendon. J Bone Joint Surg Am 817:1019–1036Google Scholar
  6. 6.
    Assal M, Jung M, Stern R et al (2002) Limited open repair of Achilles tendon ruptures: a technique with a new instrument and findings of a prospective multicenter study. J Bone Joint Surg Am 84:161–170PubMedGoogle Scholar
  7. 7.
    Buchgraber A, Pässler HH (1997) Percutaneus repair of Achilles tendon rupture: immobilization versus functional postoperative treatment. Clin Orthop 341:113–122PubMedGoogle Scholar
  8. 8.
    Cetti R, Christensen SE, Ejsted R et al (1993) Operative versus nonoperative treatment of Achilles tendon rupture. A prospective randomized study and review of the literature. Am J Sports Med 21:791–799PubMedCrossRefGoogle Scholar
  9. 9.
    Möller M, Movin T, Granhed H et al (2001) Acute rupture of tendo Achillis. A prospective, randomized study of comparison between surgical and non-surgical treatment. J Bone Joint Surg Br 83:843–848PubMedCrossRefGoogle Scholar
  10. 10.
    Kocher MS, Bishop J, Marshall R, Briggs KK, Hawkins RJ (2002) Operative versus nonoperative management of acute Achilles tendon rupture: expected-value decision analysis. Am J Sports Med 306:783–790Google Scholar
  11. 11.
    Wills C, Washburn S, Caiozzo V, Prietto CA (1986) Achilles tendon rupture: a review of the literature comparing surgical versus nonsurgical treatment. Clin Orthop Relat Res 207:156–163PubMedGoogle Scholar
  12. 12.
    Crolla RMPH, van Leeuwen DM, van Ramshorst B et al (1987) Acute rupture of the tendo calcaneus. Surgical repair with functional after treatment. Acta Orthop Belg 53:492–494PubMedGoogle Scholar
  13. 13.
    Moher D, Liberati A, Tetzlaff J, Altman DG, Group P (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 339:b2535PubMedCrossRefGoogle Scholar
  14. 14.
    Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D, Stroup DF (1999) Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Quality of reporting of meta-analyses. Lancet 354(9193):1896–900PubMedCrossRefGoogle Scholar
  15. 15.
    Cook KD, Clark G, Lui E et al (2010) Strength of braided polyblend polyethylene sutures versus braided polyester sutures in Achilles tendon repair: a cadaveric study. J Am Podiatr Med Assoc 100:185–188PubMedGoogle Scholar
  16. 16.
    Cretnik A, Zlajpah L, Smrkolj V, Kosanovic M (2000) The strength of percutaneous methods of repair of the Achilles tendon: a biomechanical study. Med Sci Sports Exerc 32:16–20PubMedCrossRefGoogle Scholar
  17. 17.
    Gebauer M, Beil FT, Beckmann J et al (2007) Mechanical evaluation of different techniques for Achilles tendon repair. Arch Orthop Trauma Surg 127:795–799PubMedCrossRefGoogle Scholar
  18. 18.
    Herbort M, Haber A, Zantop T et al (2008) Biomechanical comparison of the primary stability of suturing Achilles tendon rupture: a cadaver study of Bunnell and Kessler techniques under cyclic loading conditions. Arch Orthop Trauma Surg 128:1273–1277PubMedCrossRefGoogle Scholar
  19. 19.
    Huffard B, O'Loughlin PF, Wright T et al (2008) Achilles tendon repair: Achillon system vs. Krackow suture: an anatomic in vitro biomechanical study. Clin Biomech (Bristol, Avon) 23:1158–1164CrossRefGoogle Scholar
  20. 20.
    Jaakkola JI, Hutton WC, Beskin JL, Lee GP (2000) Achilles tendon rupture repair: biomechanical comparison of the triple bundle technique versus the Krakow locking loop technique. Foot Ankle Int 21:14–17PubMedGoogle Scholar
  21. 21.
    Labib SA, Rolf R, Dacus R, Hutton WC (2009) The "Giftbox" repair of the Achilles tendon: a modification of the Krackow technique. Foot Ankle Int 30:410–414PubMedCrossRefGoogle Scholar
  22. 22.
    Lee SJ, Goldsmith S, Nicholas SJ et al (2008) Optimizing Achilles tendon repair: effect of epitendinous suture augmentation on the strength of achilles tendon repairs. Foot Ankle Int 29:427–432PubMedCrossRefGoogle Scholar
  23. 23.
    McCoy BW, Haddad SL (2010) The strength of Achilles tendon repair: a comparison of three suture techniques in human cadaver tendons. Foot Ankle Int 31:701–705PubMedCrossRefGoogle Scholar
  24. 24.
    Shepard ME, Lindsey DP, Chou LB (2007) Biomechanical testing of epitenon suture strength in Achilles tendon repairs. Foot Ankle Int 28:1074–1077PubMedCrossRefGoogle Scholar
  25. 25.
    Zandbergen RA, de Boer SF, Swierstra BA et al (2005) Surgical treatment of achilles tendon rupture: examination of strength of 3 types of suture techniques in a cadaver model. Acta Orthop 76:408–411PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Patrick Sadoghi
    • 1
    • 2
    Email author
  • Claudio Rosso
    • 3
    • 4
  • Victor Valderrabano
    • 3
  • Andreas Leithner
    • 2
  • Patrick Vavken
    • 1
    • 5
  1. 1.Sports Medicine Research Laboratory, Department of Orthopedic Surgery, Children’s Hospital BostonHarvard Medical SchoolBostonUSA
  2. 2.Department of Orthopaedic SurgeryMedical University of GrazGrazAustria
  3. 3.Department of Orthopaedic SurgeryUniversity Hospital BaselBaselSwitzerland
  4. 4.Center for Advanced Orthopaedic StudiesBeth Israel Deaconess Medical Center and Harvard Medical SchoolBostonUSA
  5. 5.Harvard Center for Population and Development StudiesHarvard School of Public HealthBostonUSA

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