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

Abstract

Background:Chronic noninsertional Achilles tendinosis can result in an acute Achilles tendon rupture with a short distal stump. In such tendon ruptures, there is a limited amount of adequate tissue that can hold suture, thus presenting a challenge for surgeons who elect to treat the rupture operatively.Hypothesis:Adding suture anchors to the repair construct may result in biomechanically stronger repairs compared with a suture-only technique.Study Design:Controlled laboratory study.Methods:Nine paired Achilles-calcaneus complexes were harvested from cadavers. An artificial Achilles rupture was created 2 cm proximal to the insertion on the calcaneus. One specimen from each cadaver was assigned to a suture-only or a suture anchor–augmented repair. The contralateral specimen of the same cadaver received the opposing repair. Cyclic testing was then performed at 10 to 100 N for 2000 cycles, and load-to-failure testing was performed at 0.2 mm/s. This was followed by analysis of repair displacement, gapping at repair site, peak load to failure, and failure mode.Results:The suture anchor–augmented repair exhibited a 116% lower displacement compared with the suture-only repair (mean ± SD, 1.54 ± 1.13 vs 3.33 ± 1.47 mm, respectively; P < .03). The suture anchor–augmented repair also exhibited a 45% greater load to failure compared with the suture-only repair (303.50 ± 102.81 vs 209.09 ± 48.12 N, respectively; P < .04).Conclusion:Suture anchor–augmented repairs performed on acute Achilles tendon ruptures with a short distal stump are biomechanically stronger than suture-only repairs.Clinical Relevance:Our results support the use of suture anchor–augmented repairs for a biomechanically stronger construct in Achilles tendon ruptures with a short distal stump. Biomechanically stronger repairs may lead to less tendon repair gapping and failure, increasing the ability to start early active rehabilitation protocols and thus improving patient outcomes.

High-Energy Achilles Tendon Rupture With Associated Medial Malleolus Fracture and Traumatic Peroneal Dislocation: A Case Report

“…We elected to treat the Achilles tendon rupture with a percutaneous tendon to bone fixation for several reasons, including less soft-tissue dissection, smaller incision size, and excellent strength of repair to facilitate early rehabilitation. 32,33 Missed or delayed diagnosis is common in these combination injuries. Of the 17 simultaneous ankle fractures and Achilles tendon ruptures, there were 8 Achilles ruptures that were initially missed [10][11][12]15,19,20,22,24 and 2 fractures that were initially missed.…”

Achilles Tendon Ruptures: Limited Incision Repair

“…30 In case of very distal ruptures, anchor-related tendon repair may be of particular interest. 32 Despite the results being mixed to some extent, they may be in favor of successful early rehabilitation, especially after techniques involving locking sutures and anchors, which may be of major importance in high-level athletes. An article by Byrne and colleagues presented the case of an elite bobsled pilot, who suffered an acute rupture of the Achilles tendon and was treated after 11 days with knotless anchor fixation at the calcaneum.…”

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

“…A total of 1000 cycles were performed and the samples loaded from 5 to 20 N in each cycle (Fig 3). The displacement rate and the cyclic loading regime are based on previous studies and appear to be in physiological range [14,19,[24][25][26][27][28]. The displacement was recorded at 100, 500, 750, and 1000 cycles.…”