Achilles tendon rupture: experimental results on spontaneous repair in a sheep-model.
We studied the course of spontaneous healing of Achilles tendons in a sheep model after transection and partial resection of the tendon by means of histological and biomechanical analyses. In 18 sheep used for another animal study the operated knee had to be excluded from weight-bearing; therefore the Achilles tendons were transected and for 1.5 cm partially resected in the middle substance of the tendon. For evaluation these spontaneously healed tendons (n = 18) were compared with the contralateral noninvolved tendons (n = 18). Specimens were analyzed 3, 6, and 12 months postoperatively by means of histology, polarized light, angiography, and mechanically analyzing the specific tensile strength and absolute tensile strength. We found that in all animals the resected tendon healed spontaneously. All animals exhibited a normal gait pattern at least 6 weeks postoperatively. Histologically, the tendinous area of healing demonstrated after 3 months a fibrous collagenous tissue with a loose fiber orientation. The cross-sectional area had at 3 months increased to maximum but decreased later. Concomitantly the fiber orientation improved with time and 12 months after transection the specimens showed a nearly normal histological structure of the healed tendon. Biomechanically the specimens exhibited a rather low specific rupture force after 3 months (28.8% of normal tendons) and 6 months (30.2%) but increased after 12 months (56.7%). In regard to the resulting total rupture force the decrease in the spontaneously healed tendons was less (75.6% after 3 months, 56.1% after 6 months, 81.18% after 12 months), because the cross-sectional area of the healing tendon had significantly (P < 0.05) increased to maximum after 3 and 6 months. Sheep Achilles tendons thus healed spontaneously without any immobilization. The initial healing mechanism is thickening of the scar tissue with improvement of the fiber orientation towards a tendonlike structure within 1 year. Parallel to this, the specific rupture force increased and the thickness of the newly tendonlike area decreased.
Bruns
J
J
Center of Biomechanics, Department of Orthopedic Surgery, University of Hamburg, Martinistrasse 52, 20246 Hamburg, Germany. j.bruns@uke.uni-hamburg.de
Kampen
J
J
Kahrs
J
J
Plitz
W
W
D000125:Achilles Tendon / Q000293:injuries* / Q000503:physiopathology; D000818:Animals; D001696:Biomechanical Phenomena; D023421:Models, Animal; D012421:Rupture; D012756:Sheep; D014945:Wound Healing