Mechanical evaluation of different techniques for Achilles tendon repair.
BACKGROUND
One aim of the surgical treatment of acute Achilles tendon ruptures is to obtain a maximum primary stability of the sutured tendon. Therefore, we investigated the primary stability of sutured human Achilles tendons depending on different applied techniques.


METHODS
The strength of 60 repaired cadaveric human Achilles tendons was tested depending on either the suture technique (Bunnell or Kessler), the suture material (PDS-thread or PDS-cord) or an additional plantaris tendon augmentation (PDS-thread with or without augmentation). Following anatomic reconstruction the repaired specimens were loaded to failure.


RESULTS
The use of Bunnell's technique resulted in a stronger primary suture stability compared to Kessler's technique. Sutures carried out with a PDS-thread were of lower strength than those accomplished with a PDS-cord (Bunnell: thread 139 N +/- 29.8; cord 291 N +/- 55.2/Kessler: thread 137 N +/- 37.3; cord 180 N +/- 41.1). Sutures performed according to Bunnell's technique with a PDS-thread and an additional autologous plantaris tendon augmentation reached the highest primary stability (326 N +/- 124.9).


CONCLUSIONS
The findings identify the Achilles tendon suture with a PDS-cord according to Bunnell's technique as a mechanically strong method. A plantaris tendon augmentation in addition to a PDS-thread can even add more stability to the Achilles tendon suture.
Gebauer
Matthias
M
Department of Trauma, Hand- and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Martinistr 52, 20246, Hamburg, Germany. mgebauer@uke.uni-hamburg.de
Beil
Frank Timo
FT
Beckmann
Johannes
J
Sárváry
András M
AM
Ueblacker
Peter
P
Ruecker
Andreas H
AH
Holste
Joerg
J
Meenen
Norbert M
NM
D000125:Achilles Tendon / Q000293:injuries / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001696:Biomechanical Phenomena; D002102:Cadaver; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012421:Rupture; D013536:Suture Techniques; D013708:Tendon Injuries / Q000601:surgery*