Hide All

2009 Publications

Cyclic Loading of 3 Achilles Tendon Repairs Simulating Early Postoperative Forcesby Steven J. Lee, MD, Michael J. Sileo,* MD, Ian J. Kremenic, ME, Karl Orishimo, MS, Simon Ben-Avi, PhD, Stephen J. Nicholas, MD, and Malachy McHugh, PhD. - last modified 2013-02-09 23:48
Am J Sports Med. 2009 Apr;37(4):786-90. Epub 2009 Feb 9.


Background: Accelerated rehabilitation has been advocated after Achilles tendon repair, but it produces significant forces at the repair site.

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.