Cyclic Loading of 3 Achilles Tendon Repairs Simulating Early Postoperative Forces

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Abstract

Background:

Accelerated rehabilitation has been advocated after Achilles tendon repair, but it produces significant forces at the repair site.

Hypothesis:

Stresses applied to the repaired Achilles tendon simulating postoperative forces may exceed the strength of some repairs.

Study Design:

Controlled laboratory study.

Methods:

Fifteen Achilles tendons were incised 4 cm proximal to the calcaneal insertion, then were repaired using either a percutaneous, 4-strand Krackow, or an epitendinous augmented 4-strand Krackow technique. Tendons were cyclically loaded to 1000 cycles each at 100, 190, and 369 N. The number of cycles to initial gapping, 5-mm gapping, and total failure were compared using Mann-Whitney U tests with adjustments for multiple comparisons.

Results:

Gap resistance was significantly greater for augmented Krackow repairs (2208 cycles to initial gapping) versus nonaugmented repairs (502 cycles, P = .024) and for nonaugmented Krackow repairs versus percutaneous repairs (5 cycles, P = .024). All percutaneous repairs failed during the 100-N cycling (102 ± 135 cycles). All nonaugmented Krackow repairs failed during the 190-N cycles (total cycles to failure: 1268 ± 345). All augmented Krackow repairs were intact (no gapping) after the 190-N cycles. Four failed during 369-N cycling (total cycles to failure, 2017 ± 11), and 1 remained intact for 3000 cycles.

Conclusion:

Epitendinous cross-stitch weave augmentation of Achilles tendon repairs significantly increased repair strength and gap resistance.

Clinical Relevance:

Epitendinous cross-stitch weave augmentation of Achilles tendon repairs may better allow for early stretching and ambulation after Achilles tendon repair.

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