Knotted Versus Knotless Suture Bridge Repair of the Achilles Tendon Insertion

Abstract

This study demonstrated that the knotless suture bridge repair had a significantly lower load to failure than the knotted suture bridge. Surgeons should be aware of these biomechanical differences, as they influence the postoperative rehabilitation protocol and may lead to higher surgical complication rates.

Double-Row Bridging Suture Fixation Augmented With Double Krackow Suture for the Repair of Avulsion of the Ossified Achilles Tendon

“…Additionally, the knotless SutureBridge system (Arthrex Inc) was used in the clinical studies mentioned above. 9,15,17 However, the failure load of the system was 197 N, which was significantly lower than that of the knotted suture bridge, which was 317 N. 7 Because forces in the Achilles tendon are 190 N and 369 N while the patient is walking in a CAM walker with and without a 1-inch heel lift, respectively, 1 the bridging suture alone may not be sufficient to enable accelerated rehabilitation after reattachment of total avulsion of the Achilles tendon.…”

“…9,15,17 However, biomechanical studies on completely detached Achilles tendons have shown that the suture bridge technique may not have biomechanical advantages over the single-row suture technique. 4,7,14 We describe bridging suture fixation augmented with double Krackow suture for avulsion of the ossified Achilles tendon at its insertion site to restore the stable Achilles tendon insertion.…”

Suture-Only Repair Versus Suture Anchor–Augmented Repair for Achilles Tendon Ruptures With a Short Distal Stump

“…Each specimen was obtained by transecting the Achilles tendon approximately 12 cm proximal to its insertion onto the calcaneus followed by disarticulation of the calcaneus. 7 All specimens were inspected for any preexisting pathology and for gross abnormality. Additional soft tissue was resected until the specimen consisted of only the Achilles tendon and the calcaneus.…”

“…This allowed for conditioning elongation and accounts for the toe region on the stress-strain curve. 7 , 10 After the Achilles repair construct was preloaded, the repair length was measured using manual calipers. The measurement was taken from the suture at the most proximal point to the most distal extent of the repair.…”

“…The Achilles tendon has been shown to endure peak forces of greater than 2000 N during normal ambulation and forces of greater than 300 N during ambulation with the ankle immobilized in neutral dorsiflexion. 7 , 23 With the increasing popularity of early rehabilitation protocol application, it is essential that repairs be biomechanically strong enough to withstand the gap-forming forces placed on them at earlier stages of healing.…”