The effect of an inclined landing surface on biomechanical variables during a jumping task
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Cyclic Loading of 3 Achilles Tendon Repairs Simulating Early Postoperative Forces
Am J Sports Med. 2009 Apr;37(4):786-90. Epub 2009 Feb 9.
Hypothesis: Stresses applied to the repaired Achilles tendon simulating postoperative forces may exceed the strength of some repairs.
Study Design: Controlled laboratory study.
Methods: Fifteen Achilles tendons were incised 4 cm proximal to the calcaneal insertion, then were repaired using either a percutaneous, 4-strand Krackow, or an epitendinous augmented 4-strand Krackow technique. Tendons were cyclically loaded to 1000 cycles each at 100, 190, and 369 N. The number of cycles to initial gapping, 5-mm gapping, and total failure were compared using Mann-Whitney U tests with adjustments for multiple comparisons.
Results: Gap resistance was significantly greater for augmented Krackow repairs (22208 cycles to initial gapping) versus nonaug- mented repairs (5502 cycles, P = 0.024) and for nonaugmented Krackow repairs versus percutaneous repairs (55 cycles, P = 0.024). All percutaneous repairs failed during the 100-N cycling (1102 +/- 135 cycles). All nonaugmented Krackow repairs failed during the 190-N cycles (total cycles to failure: 1268 +/- 345). All augmented Krackow repairs were intact (no gapping) after the 190-N cycles. Four failed during 369-N cycling total cycles to failure, 2017 +/- 11), and 1 remained intact for 3000 cycles.
Conclusion: Epitendinous cross-stitch weave augmentation of Achilles tendon repairs significantly increased repair strength and gap resistance.
Clinical Relevance: Epitendinous cross-stitch weave augmentation of Achilles tendon repairs may better allow for early stretching and ambulation after Achilles tendon repair.