To compare the load at failure and stiffness associated with three surgical techniques for distal Achilles tendon reconstruction (AT).
Nine matched pairs of fresh-frozen human cadaveric ATs were divided into three groups. Distal AT reconstruction was performed using suture anchors or one of two lengths of tendon overlap (10 or 5 mm). Each tendon was loaded to failure. The load at failure (N), stiffness (N/mm), and mode of failure were recorded. Differences in load at failure and stiffness were analysed.
Mean load at failure was significantly higher in the 10-mm group than in the 5-mm group (p < 0.05) or the suture-anchor group (p < 0.05). Load at failure did not differ significantly between the suture-anchor and 5-mm group, and stiffness did not differ significantly between any two groups. In the 10- and 5-mm groups, failure was caused by the grafts pulling out through the substance of the AT. Modes of failure varied in the suture-anchor group.
The load at failure was higher in the 10-mm group than in the 5-mm and suture-anchor groups. Although all three surgical techniques provide sufficient primary load-bearing ability, the 10-mm tendon-overlap technique may be more conducive to early post-operative rehabilitation.
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Aspenberg P (2007) Stimulation of tendon repair: mechanical loading, GDFs and platelets: a mini-review. Int Orthop 31:783–789
Barber FA, Herbert MA (2013) Cyclic loading biomechanical analysis of the pullout strengths of rotator cuff and glenoid anchors: 2013 update. Arthroscopy 29:832–844
Bushnell BD, Byram IR, Weinhold PS, Creighton RA (2006) The use of suture anchors in repair of the ruptured patellar tendon: a biomechanical study. Am J Sports Med 34:1492–1499
Davis WL, Singerman R, Labropoulos PA, Victoroff B (1999) Effect of ankle and knee position on tension in the Achilles tendon. Foot Ankle Int 20:126–131
Finni T, Komi PV, Lukkariniemi J (1998) Achilles tendon loading during walking: application of a novel optic fiber technique. Eur J Appl Physiol 77:289–291
Huang J, Wang C, Ma X, Wang X, Zhang C, Chen L (2014) Rehabilitation regimen after surgical treatment of acute Achilles tendon ruptures: a systematic review with meta-analysis. Am J Sports Med. doi:10.1177/0363546514531014
Kearney RS, Costa ML (2012) Current concepts in the rehabilitation of an acute rupture of the tendo Achillis. J Bone Joint Surg Br 94:28–31
Kiliçoğlu O, Türker M, Yildız F, Akalan E, Temelli Y (2014) Suture anchor tenodesis in repair of distal Achilles tendon injuries. Eur J Orthop Surg Traumatol 24:117–122
Kraemer R, Lorenzen J, Rotter R, Vogt PM, Knobloch K (2009) Achilles tendon suture deteriorates tendon capillary blood flow with sustained tissue oxygen saturation—an animal study. J Orthop Surg Res 12:32–37
Kim KC, Shin HD, Cha SM, Lee WY (2013) Comparison of repair integrity and functional outcomes for 3 arthroscopic suture bridge rotator cuff repair techniques. Am J Sports Med 41:271–277
Krych AJ, Thompson M, Knutson Z, Scoon J, Coleman SH (2013) Arthroscopic labral repair versus selective labral debridement in female patients with femoroacetabular impingement: a prospective randomized study. Arthroscopy 29:46–53
Kjaer M, Langberg H, Miller BF (2005) Metabolic activity and collagen turnover in human tendon in response to physical activity. J Musculoskelet Neuronal Interact 5:41–52
Lafosse L, van Raebroeckx A, Brzoska R (2006) A new technique to improve tissue grip: “the lasso-loop stitch”. Arthroscopy 22:1246e1–1246e3
Lee SJ, Goldsmith S, Nicholas SJ, McHugh MP, Kremenic IJ, Ben-Avi S (2008) Optimizing Achilles tendon repair: effect of epitendinous suture augmentation on the strength of AT repairs. Foot Ankle Int 29:427–432
Lin EC, Mall NA, Dhawan A, Sherman SL, McGill KC (2013) Arthroscopic primary rotator cuff repairs in patients aged younger than 45 years. Arthroscopy 29:811–817
Maffulli N, Longo UG, Spiezia F, Denaro V (2010) Free hamstrings tendon transfer and interference screw fixation for less invasive reconstruction of chronic avulsions of the Achilles tendon. Knee Surg Sports Traumatol Arthrosc 18:269–273
Maffulli N, Spiezia F, Longo UG, Denaro V (2010) Less-invasive reconstruction of chronic Achilles tendon ruptures using a peroneus brevis tendon transfer. Am J Sports Med 38:2304–2312
Maffulli N, Spiezia F, Testa V, Capasso G, Longo UG, Denaro V (2012) Free gracilis tendon graft for reconstruction of chronic tears of the Achilles tendon. J Bone Joint Surg Am 94:906–910
Mullaney MJ, McHugh MP, Tyler TF, Nicholas SJ, Lee SJ (2006) Weakness in end-range plantar flexion after Achilles tendon repair. Am J of Sports Med 34:1120–1125
Orishimo KF, Burstein G, Mullaney MJ (2008) Effect of knee flexion angle on Achilles tendon force and ankle joint plantarflexion moment during passive dorsiflexion. J Foot Ankle Surg 47:34–39
Ortiz C, Wagner E, Mocoçain P, Labarca G, Keller A, Del Buono A, Maffulli N (2012) Biomechanical comparison of four methods of repair of the Achilles tendon. A laboratory study with bovine tendons. J Bone Joint Surg Br 94:663–667
Petri M, Dratzidis A, Brand S, Calliess T, Hurschler C, Krettek C, Jagodzinski M, Ettinger M (2014) Suture anchor repair yields better biomechanical properties than transosseous sutures in ruptured quadriceps tendons. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-014-2854-3
Rigby RB, Cottom JM, Vora A (2013) Early weightbearing using Achilles suture bridge technique for insertional Achilles tendinosis: a review of 43 patients. J Foot Ankle Surg 52:575–579
Schepull T, Aspenberg P (2013) Early controlled tension improves the material properties of healing human Achilles tendons after ruptures: a randomized trial. Am J Sports Med 41:2550–2557
Sebastian H, Datta B, Maffulli N, Neil M, Walsh WR (2007) Mechanical properties of reconstructed Achilles tendon with transfer of peroneus brevis or flexor hallucis longus tendon. J Foot Ankle Surg 46:424–428
Scheibel M, Schröder RJ, Chen J, Bartsch M (2011) Arthroscopic soft tissue tenodesis versus bony fixation anchor tenodesis of the long head of the biceps tendon. Am J Sports Med 39:1046–1052
Song SY, Kim IS, Chang HG, Shin JH, Kim HJ, Seo YJ (2013) Anatomic medial patellofemoral ligament reconstruction using patellar suture anchor fixation for recurrent patellar instability. Knee Surg Sports Traumata Arthrosc. doi:10.1007/s00167-013-2730-6
Wang J, Hua Y, Chen S, Li H, Zhang J, Li Y (2014) Arthroscopic repair of lateral ankle ligament complex by suture anchor. Arthroscopy 30:766–773
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Wu, Z., Hua, Y., Li, H. et al. Biomechanical comparison of three methods for distal Achilles tendon reconstruction. Knee Surg Sports Traumatol Arthrosc 23, 3756–3760 (2015). https://doi.org/10.1007/s00167-014-3176-1
- Chronic Achilles tendon rupture
- Achilles tendon reconstruction
- Suture anchor