TY - JOUR
T1 - Proximal and Distal Failure Site Analysis in Percutaneous Achilles Tendon Rupture Repair
AU - Wagner, Pablo
AU - Wagner, Emilio
AU - López, Mario
AU - Etchevers, Gastón
AU - Valencia, Oscar
AU - Guzmán-Venegas, Rodrigo
PY - 2019/12/1
Y1 - 2019/12/1
N2 - Background: Different techniques have been described for percutaneous Achilles tendon rupture repair, but no biomechanical evaluation has been performed separately for proximal and distal suturing techniques. The purpose of this study was to biomechanically analyze proximal versus distal percutaneous Achilles suture configurations during cyclic loading and load to failure. Methods: A simulated, midsubstance rupture was created 6 cm proximal to the calcaneal insertion in fresh-frozen cadaveric Achilles tendons. Fifteen proximal specimens were divided into 3 groups: (A1) triple locking technique, (A2) Bunnell-type technique, and (A3) double Bunnell-type technique. Twelve distal specimens were divided into 2 groups: (B1) triple nonlocking technique and (B2) oblique technique. Repairs were subjected to cyclic testing and load to failure. Load to failure, cause of failure, and tendon elongation were evaluated. Results: None of the proximal specimens and 7/12 of the distal ones failed in cyclic testing. The proximal fixation groups demonstrated significantly more strength than the distal groups (P =.001), achieving up to 710 N of failure load in Group A3. Groups B1and B2 failed on average at 380 N with no difference between them (P >.05). The majority of all repairs failed in the suture-tendon interface. Distal groups had more elongation during cyclic testing (13.7 mm) than proximal groups (9.4 mm) (P =.02). Conclusion: The distal fixation site in this Achilles tendon repair was significantly weaker than the proximal fixation site. A proximal modified suture configuration increased resistance to cyclic loading and load to failure significantly. Clinical Relevance: A modification can be suggested to improve strength of the Achilles repair.
AB - Background: Different techniques have been described for percutaneous Achilles tendon rupture repair, but no biomechanical evaluation has been performed separately for proximal and distal suturing techniques. The purpose of this study was to biomechanically analyze proximal versus distal percutaneous Achilles suture configurations during cyclic loading and load to failure. Methods: A simulated, midsubstance rupture was created 6 cm proximal to the calcaneal insertion in fresh-frozen cadaveric Achilles tendons. Fifteen proximal specimens were divided into 3 groups: (A1) triple locking technique, (A2) Bunnell-type technique, and (A3) double Bunnell-type technique. Twelve distal specimens were divided into 2 groups: (B1) triple nonlocking technique and (B2) oblique technique. Repairs were subjected to cyclic testing and load to failure. Load to failure, cause of failure, and tendon elongation were evaluated. Results: None of the proximal specimens and 7/12 of the distal ones failed in cyclic testing. The proximal fixation groups demonstrated significantly more strength than the distal groups (P =.001), achieving up to 710 N of failure load in Group A3. Groups B1and B2 failed on average at 380 N with no difference between them (P >.05). The majority of all repairs failed in the suture-tendon interface. Distal groups had more elongation during cyclic testing (13.7 mm) than proximal groups (9.4 mm) (P =.02). Conclusion: The distal fixation site in this Achilles tendon repair was significantly weaker than the proximal fixation site. A proximal modified suture configuration increased resistance to cyclic loading and load to failure significantly. Clinical Relevance: A modification can be suggested to improve strength of the Achilles repair.
KW - Achilles percutaneous repair
KW - Achilles tendon
KW - Achilles tendon rupture
KW - biomechanical analysis
KW - cyclic loading
KW - minimally invasive Achilles repair
KW - Achilles percutaneous repair
KW - Achilles tendon
KW - Achilles tendon rupture
KW - biomechanical analysis
KW - cyclic loading
KW - minimally invasive Achilles repair
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U2 - 10.1177/1071100719867937
DO - 10.1177/1071100719867937
M3 - Article
C2 - 31462088
SN - 1071-1007
VL - 40
SP - 1424
EP - 1429
JO - Foot and Ankle International
JF - Foot and Ankle International
IS - 12
ER -