Initial Achilles tendon repair strength—synthesized biomechanical data from 196 cadaver repairs

Sadoghi, Patrick; Rosso, Claudio; Valderrábano, Víctor; Leithner, Andreas; Vavken, Patrick

doi:10.1007/s00264-012-1533-6

Cited by 49 publications

(35 citation statements)

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“…Tissue engineering of ligaments and tendons is an upcoming topic in orthopaedics surgery and regenerative medicine. The involved injuries, for example, ruptures, tears, and chronic tendinopathy of the rotator cuff (RC), the anterior cruciate ligament (ACL), the patellar tendon (PT), and the Achilles tendon (AT) have long and potentially serious sequelae and occur at high incidences . Consequently, there is a substantial amount of research done in this area in order to improve techniques of tissue repair and tissue regeneration …”

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Effect of platelet-rich plasma on the biologic activity of the human rotator-cuff fibroblasts: A controlled in vitro study

et al. 2013

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To assess the in vitro effect of platelet-rich plasma (PRP) on biological activity of the human rotator cuff fibroblasts and to describe the optimal dose-response to maximize cellular stimulation while reducing potential risk. Rotator cuff (RC) fibroblasts of n ¼ 6 patients (mean age of 65.2 years) undergoing arthroscopic cuff tear reconstruction were cultured in vitro for 21 days and stimulated with PRP in three different concentrations (1-, 5-, and 10-fold). Samples were obtained for DNA and GAG measurement at 1, 7, 14, and 21 days. The biological outcomes were regressed on the PRP concentration. The application of PRP significantly influenced the fibroblast proliferation and activity of the human rotator cuff with elevated glycosaminoglycan (GAG) and DNA levels. The dosage of PRP had the significantly highest impact on this proliferation using a onefold or fivefold application. PRP has a significant effect on fibroblast proliferation of the human rotator cuff in vitro with an optimal benefit using a onefold or fivefold PRP concentration. This study justifies further in vivo investigations using PRP at the human rotator cuff. ß

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Effect of platelet-rich plasma on the biologic activity of the human rotator-cuff fibroblasts: A controlled in vitro study

et al. 2013

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“…Long-term sequelae of Achilles tendon ruptures can be grave: the injured athlete has to rest, and consequences such as therapy, rehabilitation costs and absence from work pose a substantial socio-economic cost. Thus, it is of pivotal importance, both on the individual and societal level, to identify those therapies with the best outcomes [28].…”

Section: Introductionmentioning

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Long-term outcomes of muscle volume and Achilles tendon length after Achilles tendon ruptures

Rosso

Vavken

Polzer

et al. 2013

Knee Surg Sports Traumatol Arthrosc

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Purpose The best treatment for Achilles tendon (AT) ruptures remains controversial. Long-term follow-up with radiological and clinical measurements is needed. Methods In this retrospective multicentre cohort study, patients (n = 52) were assessed at a mean of 91 months follow-up after unilateral AT rupture treated by open, percutaneous or conservative (non-surgical) treatment. Demographic parameters, time off work, maximum calf circumference and clinical scores (ATRS, Hannover, AOFAS) were evaluated. Muscle volume and cross-sectional area of the calf and AT length were measured on MR images and were compared between groups and to each patient's healthy contralateral leg. Results Reduced muscle volume was found across all groups with a higher muscle volume in the conservative (729.9 ± 130.3 cm 3 ) compared to the percutaneous group (675.9 ± 207.4 cm 3 , p = 0.04). AT length was longer in the affected leg (198.4 ± 24.1 vs. 180.6 ± 25.0 mm, p \ 0.0001) without difference in subgroup analysis. Clinically measured ankle dorsiflexion showed poor correlation with AT length (R 2 = 0.07, p = 0.008). Muscle volume strongly correlated with the cross-sectional area (R 2 = 0.6, p \ 0.0001) but showed a weak correlation with the Hannover score (R 2 = 0.08, p = 0.048). Maximum calf circumference correlated with muscle volume (R 2 = 0.42, p \ 0.0001). Conclusions No significant difference between the treatment groups was found in muscle volume, AT length, clinical measures or days off work. Cross-sectional area and maximum calf circumference are cost-effective measurements and a good approximation of muscle volume and can thus be used in a clinical setting while clinical dorsiflexion should not be used. Level of evidence III.

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“…Bundle-to-bundle suturing for Achilles tendon rupture is the most effective operation method to restore the anatomical structure and physiological characteristics of the tendon [4][5][6]. Open repair allows for direct repair of the rupture site and achievement of maximum mechanical stability [4][5][6][7]21]; however, the complex sutures used in this technique can form a fiber block of the Achilles tendon that may result in keloid formation and shortening of the Achilles tendon [12,[22][23][24][25][26]. Open repair also causes scar contracture of the Achilles tendon, which has been described previously [27].…”

Section: Discussionmentioning

confidence: 99%

Modified Bunnell suture versus bundle-to-bundle suture for acute Achilles tendon rupture: A prospective comparative study of patients aged <45 years

wang

Liu

et al. 2020

Preprint

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Background: This study was performed to compare the operative outcome between percutaneous repair (modified Bunnell suture) and open repair (bundle-to-bundle suture) for treatment of acute Achilles tendon rupture.Methods: Seventy-two consecutive patients who underwent surgical treatment of Achilles tendon rupture were evaluated. Thirty-six patients were treated by the bundle-to-bundle suture technique (Group A), and 36 patients were treated by the modified Bunnell suture technique (Group B). Functional examination included measurement of the calf muscle circumference and performance of the single-leg heel-rise test. The length and diameter of the Achilles tendon were compared between the injured and uninjured sides using magnetic resonance imaging. The number of single-leg heel rises (height of >5 cm) performed within 15 s was compared between the injured and uninjured sides. The ankle joint range of motion was also recorded. The Achilles tendon total rupture score (ATRS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale score, and visual analog scale (VAS) pain score were used to evaluate the clinical outcome after a minimum 12-month postoperative follow-up period.Results: In total, 61 patients were followed up. The mean follow-up time was not significantly different between Group A (23.73 ± 2.81 months) and Group B (22.61 ± 3.96 months). However, there were significant differences in the heel-rise test (Group A, 1.74 ± 0.96; Group B, 2.37 ± 1.42) and length of the Achilles tendon (Group A, 11.98 ± 1.64 cm; Group B, 11.11 ± 1.74 cm). The calf circumference of the injured side was significantly larger in Group A than B (p = 0.043). The cross-sectional diameter of the Achilles tendon after open repair was significantly different from that after percutaneous repair. There were no significant differences in the ATRS, AOFAS score, or VAS score at the final follow-up between the two groups. One patient in Group A had delayed wound healing, which resolved in about 40 days.Conclusions: Both suture methods described in this report can provide good clinical results. The bundle-to-bundle suture technique is more effective for restoration of the Achilles tendon length and muscle function. This method is safe, effective, and worthy of promotion.

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Initial Achilles tendon repair strength—synthesized biomechanical data from 196 cadaver repairs

Abstract: Due to the small sample sizes, different study designs, and heterogeneity of strength measurement techniques, definite recommendations on surgical technique cannot be made but presented information might help in the decision making process for foot and ankle surgeons.

Cited by 49 publications

References 25 publications

Effect of platelet-rich plasma on the biologic activity of the human rotator-cuff fibroblasts: A controlled in vitro study

Effect of platelet-rich plasma on the biologic activity of the human rotator-cuff fibroblasts: A controlled in vitro study

Long-term outcomes of muscle volume and Achilles tendon length after Achilles tendon ruptures

Modified Bunnell suture versus bundle-to-bundle suture for acute Achilles tendon rupture: A prospective comparative study of patients aged <45 years

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Initial Achilles tendon repair strength—synthesized biomechanical data from 196 cadaver repairs

Abstract: Due to the small sample sizes, different study designs, and heterogeneity of strength measurement techniques, definite recommendations on surgical technique cannot be made but presented information might help in the decision making process for foot and ankle surgeons.

Cited by 49 publications

References 25 publications

Effect of platelet-rich plasma on the biologic activity of the human rotator-cuff fibroblasts: A controlled in vitro study

Effect of platelet-rich plasma on the biologic activity of the human rotator-cuff fibroblasts: A controlled in vitro study

Long-term outcomes of muscle volume and Achilles tendon length after Achilles tendon ruptures

Modified Bunnell suture versus bundle-to-bundle suture for acute Achilles tendon rupture: A prospective comparative study of patients aged &lt;45 years

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Modified Bunnell suture versus bundle-to-bundle suture for acute Achilles tendon rupture: A prospective comparative study of patients aged <45 years