title: Initial stability of two different adhesives compared to suture repair for acute Achilles tendon rupture--a biomechanical evaluation.
abstract: OBJECTIVE
  Treatment of acute subcutaneous Achilles tendon rupture remains challenging. Whereas the results of conservative and operative treatment are inconsistent, early mobilisation treatment seems to be beneficial. Besides suture repair, operative treatment using adhesives reveals promising results. Our hypothesis was that a gluing technique provides initial stability comparable to sutures.
  
  
  METHODS
  In a biomechanical study, 18 fresh frozen sheep Achilles tendons were used to compare the biomechanical properties of suture repair using PDS® II and Bunnell's technique to tendon gluing using BioGlue® and Tissucol®. Load to failure testing was performed.
  
  
  RESULTS
  Ultimate failure loads of sutures (146.2 ± 30.8 N) are significantly superior to the techniques using BioGlue® (38.4 ± 18.3 N; p <0.0001) or Tissucol® (4.7 ± 2.5 N; p <0.0001). Interestingly, no significant differences in stiffness were found between the application of BioGlue® and PDS® II.
  
  
  CONCLUSIONS
  Suture repair provides significantly superior biomechanical properties compared to the use of both tested adhesives BioGlue® and Tissucol®. Based on the presented data we recommend the use of suture material for open Achilles tendon repair.
authors.affiliation: Department of Trauma and Hand Surgery, Heinrich Heine University Hospital Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Schneppendahl
authors.forename: Simon
authors.initials: S
authors.lastname: Thelen
authors.forename: Alberto
authors.initials: A
authors.lastname: Schek
authors.forename: Ioana
authors.initials: I
authors.lastname: Bala
authors.forename: Mohssen
authors.initials: M
authors.lastname: Hakimi
authors.forename: Jan-Peter
authors.initials: JP
authors.lastname: Grassmann
authors.forename: Christian
authors.initials: C
authors.lastname: Eichler
authors.forename: Joachim
authors.initials: J
authors.lastname: Windolf
authors.forename: Michael
authors.initials: M
authors.lastname: Wild
mesh_terms: D000125:Achilles Tendon / Q000293:injuries / Q000601:surgery*; D000818:Animals; D001672:Biocompatible Materials; D001696:Biomechanical Phenomena; D019544:Equipment Failure Analysis; D008422:Materials Testing; D012421:Rupture; D012756:Sheep; D053441:Suture Anchors; D013536:Suture Techniques; D013708:Tendon Injuries / Q000601:surgery*; D014014:Tissue Adhesives
chemical_list: D001672:Biocompatible Materials; D014014:Tissue Adhesives