Biomechanical Properties of Double- and Single-Row Suture Anchor Repair for Surgical Treatment of Insertional Achilles Tendinopathy

Abstract

In treatment for insertional Achilles tendinosis, the tendon often has to be detached and anatomically reattached to its insertion at the calcaneus. To our knowledge there is a lack of biomechanical studies supporting either a number or a pattern of suture anchor fixation. Because the stresses going across the insertion site of the Achilles tendon are significant during rehabilitation and weightbearing activities, it is imperative to have a strong construct that allows satisfactory healing during the early postoperative process.

Knotted Versus Knotless Suture Bridge Repair of the Achilles Tendon Insertion

“…Although no dualenergy x-ray absorptiometry (DEXA) scan was obtained for the specimens, no failures occurred by anchor pullout so this is likely not a significant variable in the biomechanical testing we performed. Perhaps most important, this study did not address the traditional method of reattachment of the Achilles tendon with a single-row of suture anchors and, therefore, did not directly clarify some of the questions raised from the contrasting biomechanical studies conducted by Pilson et al 32 and Bietzel et al 5 Availability of cadaver resources often limits the number of specimens and experimental groups that can be tested, but future studies should include the single-row method of reattachment of the Achilles to the calcaneus if possible. Finally, we acknowledge that the accuracy of our manual measurement technique may be a weakness of the study.…”

Current Concepts Review Update: Insertional Achilles Tendinopathy

“…62 For those with greater than 50 percent detachment, reinsertion with double-row fixation has been recommended. 5,71 A recent retrospective case series by Ettinger et al (2016) found that patients who were treated with double-row fixation or 2-suture anchors showed significantly greater postoperative AOFAS scores compared to single-row anchors (79.6 vs 90.2, P < 0.05, Level IV evidence). 32 …”

Double-Row Bridging Suture Fixation Augmented With Double Krackow Suture for the Repair of Avulsion of the Ossified 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.…”