title: Tendon repair by laser welding: a histologic and biomechanical comparison and suture repair with CO2 and argon lasers.
abstract: OBJECTIVE
  The purpose of this study was to determine whether welding of tendinous tissue is possible with the application of thermal lasers. STUDY DESIGN MATERIALS AND METHODS: After sharp transection of a unilateral achilles tendon, 40 male outbred Spraque Dawley rats were divided equally between four treatment groups. Ten animals underwent repair using the modified Kessler suture technique. The remaining animals underwent application of laser after the tendon edges were reapproximated and held in place with a vascular clamp. CO2 and Nd:YAG lasers were applied using 25% human albumin as a solder. Fluorescein dye was added to albumin and used as solder for the Argon laser. Biomechanical and histologic testing were performed immediately and 14 days postoperatively.
  
  
  RESULTS
  Argon and CO2 lasers successfully fused the tendon ends together. However, immediately postoperative, the resultant tissue weld was tenuous and conventional tensile strength testing was not possible. At 14 days postoperatively, all modes of tendon repair resulted in tensile failure at consistently lower levels of tension than those required for the normal uninjured tendons. The ultimate tensile strength for the suture-repaired, CO2 laser welded, and Argon laser welded tendons were 74%, 59%, and 64% of the strength of the control tendons respectively. No statistically significant difference was found in the tensile strength among the three repair groups. Histologic evaluation at 14 days revealed the greatest degree of inflammatory response in those tendons repaired with the Argon laser. Those tendons repaired with suture demonstrated the least amount of inflammatory change.
  
  
  CONCLUSIONS
  Our study demonstrates that welding of a tendon is possible with the application of laser energy. However, we were unable to produce a weld sufficient to withstand significant tensile loads in the immediate postoperative period.
authors.affiliation: Walter Reed Army Medical Center, Department of Orthopaedic Surgery, Washington, DC 20307, USA.
authors.forename: F X
authors.initials: FX
authors.lastname: Kilkelly
authors.forename: T J
authors.initials: TJ
authors.lastname: Choma
authors.forename: N
authors.initials: N
authors.lastname: Popovic
authors.forename: D W
authors.initials: DW
authors.lastname: Miller
authors.forename: D E
authors.initials: DE
authors.lastname: Sweet
mesh_terms: D000125:Achilles Tendon / Q000473:pathology / Q000601:surgery*; D000818:Animals; D053685:Laser Therapy; D008297:Male; D011184:Postoperative Period; D051381:Rats; D017207:Rats, Sprague-Dawley; D013537:Sutures; D013718:Tensile Strength