Biomechanical Evaluation of Varying the Number of Loops in a Repair of a Physiological Model of Achilles Tendon Rupture

Grieco, Preston W.; Frumberg, David B.; Weinberg, Maxwell; Pivec, Robert; Naziri, Qais; Uribe, Jaime A.

doi:10.1177/1071100714559270

Cited by 7 publications

(6 citation statements)

References 25 publications

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“…Since a larger incision of mean 4.2 cm was used in the delayed presentation to mobilise adherent separated tendon ends, the incision provided the opportunity to strengthen the core suture repair. Recent meta-analyses of biomechanical studies have shown comparable strength for the Krackow suture and Bunnell suture [30], however, to optimise the strength of the Krackow suture, the locking loops must be inserted beyond the frayed ends of the ruptured tendon [13] increasing incision length. Using this described technique once the adherent tendon ends have been mobilised, and the percutaneous modified Bunnell and Kessler core sutures inserted, the repair strength was also be augmented by a circumferential running [20] or locking suture [14] without increasing the incision length and increasing the associated risks.…”

Section: Discussionmentioning

confidence: 99%

No difference in strength and clinical outcome between early and late repair after Achilles tendon rupture

Carmont

Zellers

Brorsson

et al. 2018

Knee Surg Sports Traumatol Arthrosc

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Purpose This retrospective study aimed to determine the patient-reported and functional outcome of patients with delayed presentation, who had received no treatment until 14 days following injury of Achilles tendon rupture repaired with minimally invasive surgery and were compared with a group of sex-and age-matched patients presenting acutely. Based on the outcomes following delayed presentation reported in the literature, it was hypothesized that outcomes would be inferior for self-reported outcome, tendon elongation, heel-rise performance, ability to return to play, and complication rates than for acutely managed patients. Methods Repair was performed through an incision large enough to permit mobilisation of the tendon ends, core suture repair consisting of a modified Bunnell suture proximally and a Kessler suture distally and circumferential running suture augmentation. Results Nine patients presented 21.8 (14.9) days (range 14-42 days) after rupture. The rate of delayed presentation was estimated to be 1 in 10. At 12 months following repair, patients with delayed treatment had median (range) ATRS score of 90 (69-99) compared with 94 (75-100) in patients treated acutely presenting 0.66 (1.7) (0-5) days. There were no significant differences between groups: ATRA [mean (SD) delayed: − 6.9° (5.5), acute: − 6° (4.7)], heel-rise height index [delayed: 79% (20), acute: 74% (14)], or heel-rise repetition index [delayed: 77% (20), acute: 71% (20)]. In the delayed presentation group, two patients had wound infection and one iatrogenic sural nerve injury. Conclusions Patients presenting more than 2 weeks after Achilles tendon rupture may be successfully treated with minimally invasive repair. Level of evidence III.

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Section: Discussionmentioning

confidence: 99%

No difference in strength and clinical outcome between early and late repair after Achilles tendon rupture

Carmont

Zellers

Brorsson

et al. 2018

Knee Surg Sports Traumatol Arthrosc

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“…Most Achilles tendon rupture ends are horsetail-like avulsions, and the quality of the tendon tissue at the rupture site is poor. Grieco et al's [18] biomechanical studies have confirmed that in the Krackow technique, suture repairs incorporated into frayed tendon portions result in significantly greater gapping and lower maximal failure forces than repairs in unfrayed tendons do. Therefore, if the locking loop suture is performed on avulsed Achilles tendon tissue, early functional rehabilitation may lead to loose locking and tendon elongation.…”

Section: Discussionmentioning

confidence: 92%

Achilles tendon rupture repair: Biomechanical comparison of the locking block modified Krackow technique and the Giftbox technique

Tian

Rui

et al. 2020

Injury

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Background: Open Giftbox repair of the Achilles tendon has good biomechanical advantages, but it is not minimally invasive. We designed a peritendon fixation technique, the "Locking Block Modified Krackow" (LBMK) technique, to meet minimally invasive needs. This study used a simulated protocol of early rehabilitation to compare the biomechanics of LBMK with those of the Giftbox technique. Methods: Twenty fresh bovine Achilles tendon specimens were randomly assigned to either the LBMK group or the Giftbox group. The LBMK technique and the Giftbox technique were used as the main suture configurations, and transverse sutures were used as secondary suture configurations in both groups. Each repaired specimen was subjected to two cyclic loading protocols (20-100 N, 20-190 N). The gapping between the tendon ends was measured after each stage of loading. Finally, all specimens underwent a load-to-failure test at a stretching rate of 25 mm/s. Results: After the first loading stage, the mean tendon gapping was 0.76 ±0.44 mm in the LBMK group and 0.86 ± 0.47 mm in the Giftbox group ( p = 0.620). After the second loading test, the average gapping measures of the LBMK and Giftbox groups were 3.8 ± 1.9 mm and 4.2 ± 2.2 mm, respectively ( p = 0.466). Finally, the catastrophic load to failure was 732.8 ± 138 N in the LBMK group and 645.5 ± 121 N in the Giftbox group. The difference was statistically significant ( p = 0.023). Conclusion:Both the LBMK and Giftbox techniques meet the requirements of early rehabilitation, but the suture strength in the LBMK group was significantly higher than that in the Giftbox group.

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“…All analyses were performed with the statistic software R (version 3.1.2, www.r-project.org) using the R-package lme4 for the linear mixed effects model. Based on the literature, we chose a sample size of N = 8 for each group [14,[30][31][32][33][34][35].…”

Section: Discussionmentioning

confidence: 99%

Comparison of the double loop knot stitch and Kessler stitch for Achilles tendon repair: A biomechanical cadaver study

et al. 2020

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Tendon elongation after Achilles tendon (AT) repair is associated with the clinical outcome. Reliable suture techniques are essential to reduce gap formations and to allow early mobilization. Cyclic loading conditions represent the repetitive loading in rehabilitation. The aim of this study was to compare the Kessler stitch and double loop knot stitch (DLKS) in a cyclic loading program focussing on gap formation. Sixteen human cadaveric ATs were transected and sutured using either the Kessler stitch or DLKS (eight matched pairs). The suture-tendon configurations were subjected to cyclic loading and additional ultimate load to failure testing using the Zwick 1446 universal testing machine. Each AT survived cyclic loading, with a mean gap formation less than 5 mm after 1000 cycles. The mechanical properties of the Kessler stitch and DLKS were not significantly different after cyclic loading with a mean displacement of 4.57 mm (± 1.16) for the Kessler stitch and 4.85 mm (± 1.14) for the DLKS (P = .76). There were no significant differences in the ultimate load testing (P = .85). Both bioprotective techniques prevent excessive gaping in cyclic testing when tendon loading is moderate. Our data and those from literature of gap formation in cyclic and ultimate loading allow the conclusion, that early aggressive AT loading after repair (e.g. full weightbearing) overstrain simple as well as complex suture configurations. Initial intraoperative tightening of the knots (preloading) before locking is important to decrease postoperative elongation.

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Biomechanical Evaluation of Varying the Number of Loops in a Repair of a Physiological Model of Achilles Tendon Rupture

Abstract: We cannot recommend attempting more limited exposures with sutures in frayed tendon as this may lead to early repair failure. We provided a physiologic model utilizing frayed tendon ends that resembles in vivo Achilles tendon rupture.

Cited by 7 publications

References 25 publications

No difference in strength and clinical outcome between early and late repair after Achilles tendon rupture

No difference in strength and clinical outcome between early and late repair after Achilles tendon rupture

Achilles tendon rupture repair: Biomechanical comparison of the locking block modified Krackow technique and the Giftbox technique

Comparison of the double loop knot stitch and Kessler stitch for Achilles tendon repair: A biomechanical cadaver study

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