title: Cyclic loading of 3 Achilles tendon repairs simulating early postoperative forces.
abstract: BACKGROUND
  The abstract goes here and covers two columns. Accelerated rehabilitation has been advocated after Achilles tendon repair, but it produces significant forces at the repair site. The abstract goes here and covers two columns.
  
  
  OBJECTIVE
  Stresses applied to the repaired Achilles tendon simulating postoperative forces may exceed the strength of some repairs.
  
  
  METHODS
  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 (2208 cycles to initial gapping) versus nonaugmented repairs (502 cycles, P = .024) and for nonaugmented Krackow repairs versus percutaneous repairs (5 cycles, P = .024). All percutaneous repairs failed during the 100-N cycling (102 +/- 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.
  
  
  CONCLUSIONS
  Epitendinous cross-stitch weave augmentation of Achilles tendon repairs significantly increased repair strength and gap resistance.
  
  
  CONCLUSIONS
  Epitendinous cross-stitch weave augmentation of Achilles tendon repairs may better allow for early stretching and ambulation after Achilles tendon repair.
authors.affiliation: Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, New York, USA.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Lee
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Sileo
authors.forename: Ian J
authors.initials: IJ
authors.lastname: Kremenic
authors.forename: Karl
authors.initials: K
authors.lastname: Orishimo
authors.forename: Simon
authors.initials: S
authors.lastname: Ben-Avi
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Nicholas
authors.forename: Malachy
authors.initials: M
authors.lastname: McHugh
mesh_terms: D000125:Achilles Tendon / Q000502:physiology / Q000601:surgery*; D000328:Adult; D006801:Humans; D008297:Male; D008875:Middle Aged; D013536:Suture Techniques; D013708:Tendon Injuries / Q000534:rehabilitation* / Q000601:surgery; D016474:Weight-Bearing