title: Button fixation technique for Achilles tendon reinsertion: a biomechanical study.
abstract: Chronic insertional tendinopathy of the Achilles tendon is a frequent and disabling pathologic entity. Operative treatment is indicated for patients for whom nonoperative management has failed. The treatment can consist of the complete detachment of the tendon insertion and extensive debridement. We biomechanically tested a new operative technique that uses buttons for fixation of the Achilles tendon insertion on the posterior calcaneal tuberosity and compared it with 2 standard bone anchor techniques. A total of 40 fresh-frozen cadaver specimens were used to compare 3 fixation techniques for reinserting the Achilles tendon: single row anchors, double row anchors, and buttons. The ultimate loads and failure mechanisms were recorded. The button assembly (median load 764 N, range 713 to 888) yielded a median fixation strength equal to 202% (range 137% to 251%) of that obtained with the double row anchors (median load 412 N, range 301 to 571) and 255% (range 213% to 317%) of that obtained with the single row anchors (median load 338 N, range 241 to 433N). The most common failure mechanisms were suture breakage with the buttons (55%) and pull out of the implant with the double row (70%) and single row (85%) anchors. The results of the present biomechanical cadaver study have shown that Achilles tendon reinsertion fixation using the button technique provides superior pull out strength than the bone anchors tested.
authors.affiliation: Orthopaedic Resident, Postgraduate Year 4, Department of Surgery, Centre Hospitalier Universitaire de Sherbrooke Faculty of Medicine, Sherbrooke, Quebec, Canada. Electronic address: david.awogni@usherbrooke.ca.
authors.forename: David
authors.initials: D
authors.lastname: Awogni
authors.affiliation: Mechanical Engineer, Mechanical Engineering Department, Centre Hospitalier Universitaire de Sherbrooke Faculty of Medicine, Sherbrooke, Quebec, Canada.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Chauvette
authors.affiliation: General Medicine Resident, Postgraduate Year 2, Department of Family Medicine, Centre Hospitalier Universitaire de Sherbrooke Faculty of Medicine, Sherbrooke, Quebec, Canada.
authors.forename: Marie-Line
authors.initials: ML
authors.lastname: Lemieux
authors.affiliation: Orthopaedic Surgeon, Department of Surgery, Centre Hospitalier Universitaire de Sherbrooke Faculty of Medicine, Sherbrooke, Quebec, Canada.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Balg
authors.affiliation: Biomechanical Engineer, Mechanical Engineering Department, University of Sherbrooke, Sherbrooke, Quebec, Canada.
authors.forename: Ève
authors.initials: È
authors.lastname: Langelier
authors.affiliation: Orthopaedic Surgeon, Department of Surgery, Centre Hospitalier Universitaire de Sherbrooke Faculty of Medicine, Sherbrooke, Quebec, Canada.
authors.forename: Jean-Pascal
authors.initials: JP
authors.lastname: Allard
mesh_terms: D000125:Achilles Tendon / Q000503:physiopathology / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D001696:Biomechanical Phenomena; D002102:Cadaver; D002111:Calcaneus / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D053441:Suture Anchors; D013536:Suture Techniques; D013708:Tendon Injuries / Q000503:physiopathology / Q000601:surgery*
keywords: Achilles tendon; buttons; insertional tendinopathy; row anchors