title: Optimizing Achilles tendon repair: effect of epitendinous suture augmentation on the strength of achilles tendon repairs.
abstract: BACKGROUND
  Epitendinous suture augmentation has been shown to increase gap resistance and overall strength in flexor tendon repairs of the hand. The purpose of this study was to evaluate the effect of various suture augmentation techniques in Achilles tendon repair.
  
  
  METHODS
  Eighteen fresh-frozen cadaveric Achilles tendons were transected and repaired with a 4-strand Krackow core stitch. Suture augmentation was performed with 3 figure-of-eight stitches in 6 specimens and a running cross-stitch weave in 6 specimens. The other 6 specimens were not augmented. Each tendon was loaded to failure on an MTS. Force to failure (defined as peak force or force at 5 mm gapping), gapping resistance, stiffness, and elongation were compared.
  
  
  RESULTS
  Force to failure (p < 0.001), stiffness (p < 0.01) and gapping resistance (p < 0.05) were increased by suture augmentation. Additionally failure force and gapping resistance for the cross-stitch augmentation was higher than the figure-of-eight augmentation (p < 0.05).
  
  
  CONCLUSIONS
  Cross-stitch augmentation of Achilles tendon repair yields a stronger and stiffer repair with greater resistance to gapping.
  
  
  CONCLUSIONS
  Achilles tendon repairs augmented with a cross stitch weave will be able to withstand substantially higher forces than non-augmented repairs.
authors.affiliation: Lenox Hill Hospital, Orthopedic Surgery, 130 East 77th Street, 5th Floor, Black Hall, New York, NY 10021. sjleemd@aol.com.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Lee
authors.forename: Scott
authors.initials: S
authors.lastname: Goldsmith
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Nicholas
authors.forename: Malachy
authors.initials: M
authors.lastname: McHugh
authors.forename: Ian
authors.initials: I
authors.lastname: Kremenic
authors.forename: Simon
authors.initials: S
authors.lastname: Ben-Avi
mesh_terms: D000125:Achilles Tendon / Q000293:injuries* / Q000503:physiopathology / Q000601:surgery*; D000328:Adult; D002102:Cadaver; D005260:Female; D006801:Humans; D008297:Male; D008422:Materials Testing; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012421:Rupture / Q000601:surgery; D013536:Suture Techniques; D013708:Tendon Injuries / Q000601:surgery*; D013718:Tensile Strength