Optimizing Achilles Tendon Repair: Effect of Epitendinous Suture Augmentation on the Strength of Achilles Tendon Repairs

Abstract

Achilles tendon repairs augmented with a cross stitch weave will be able to withstand substantially higher forces than non-augmented repairs.

Limited-Open Achilles Tendon Repair Using Locking Sutures Versus Nonlocking Sutures

“…We also found that the PARS subgroup suture paths did not have a large influence on repair strength; however, the PARS-3 subgroup did exhibit initial gapping (2.0 mm) following cyclic loading sooner than did the other PARS subgroups. However, when considering the number of cycles to gaps of 5.0 and 9.5 mm, which are more analogous to a clinical failure of the repair, 14,16 we found no difference between the 3 PARS subgroups. Our measurements of initial gapping (2.0 mm) in the specimens repaired using the Achillon device are similar to those reported in the literature.…”

“…While post hoc analyses of the 3 PARS subgroups suggested that the PARS-3 suture technique was less resistant to initial gapping, no differences were detected between PARS subgroups at tendon gaps of 5 mm or greater, which may be more clinically important. 14,16 The present study has several limitations. The cadaveric model did not permit for any healing of the tendon to occur, such that our protocol was a test of repair strength rather than an examination of how these repair techniques facilitate tendon healing.…”

“…Also, the rupture was modeled as a simple cut through the Achilles tendon approximately 4 cm above its insertion into the calcaneus rather than the "mop end" injury that is consistent with acute Achilles rupture. 9,14 It is unclear what amount of gapping observed in the laboratory would result in a failure of the tendon to heal in the clinical setting. An in vivo assessment of tendon gapping 6 weeks following surgery found that patients who were immobilized demonstrated reduced tendon gapping and less time in rehabilitation.…”

Biomechanical comparison of four methods of repair of the Achilles tendon

“…We measured the width and thickness of all specimens at the narrowest portion using a vernier caliper. 20 All the tendons were transected cleanly using a knife at 4 cm proximal to the calcaneal insertion and all were repaired using a number 2 Fiberwire suture (Arthrex, Naples, Florida). Five tendons were repaired using the Dresden technique described previously by Amlang et al 19 (group 1), five using the Krackow repair 21 (group 2), five using the modified triple-strand Dresden technique (triple technique, group 3), and five with the modified oblique Dresden technique (oblique technique, group 4) (Fig.…”

Everything Achilles: Knowledge Update and Current Concepts in Management

“…For gaps of 3 to 5 cm, V-Y advancement flaps are particularly useful 80,81 . Acellular human dermal tissue matrix has also been used for augmentation with good results 82 . Achilles tendon allografts have been used to treat large defects (approximately 10 cm); however, results are limited to case reports.…”