title: Effect of Suture Caliber and Number of Core Strands on Repair of Acute Achilles Ruptures: A Biomechanical Study.
abstract: BACKGROUND
  Controversy exists regarding the ideal Achilles rupture treatment; however, operative treatment is considered for athletes and active patients. The ideal repair construct is evolving, and the effect of suture caliber or number of core strands has not been studied.
  
  
  METHODS
  Simulated mid-substance Achilles ruptures were performed in 24 cadavers. Specimens were randomized to three 6-core-strand style repair constructs: (1) 4 No. 2 sutures and two 2-mm tapes (2T); (2) 2 No. 2 sutures and four 2-mm tapes (4T); (3) 12 (double-6-strand) strand repair (12 No. 2-0 sutures [12S]). Repairs were subjected to a cyclic loading protocol representative of postoperative rehabilitation. These data were compared to a previously published standard open repair technique (6-core strands with No. 2 sutures) on 9 specimens tested under the same conditions.6Results: No significant elongation differences were observed between the repair groups and the previously published standard repair group in the first 2 stages of the simulated rehabilitation protocol. Both the 2T and 12S repairs survived a significantly greater number of cycles to failure ( P = 0.0005, P = 0.0267, respectively) and had a significantly higher failure load ( P = .0005, P = .0118, respectively) compared to the previously published data. These 2 constructs consistently survived the advanced stages of the simulated rehabilitation protocol. The majority of repairs failed at the knots.
  
  
  CONCLUSIONS
  In this study, the 2T and 12S constructs survived the later stages of our simulated rehabilitation protocol, suggesting that they may be able to accommodate a more aggressive clinical rehabilitation protocol. Substituting suture-tape for 2 core strands or doubling the core strands with a smaller-caliber suture created a biomechanically stronger construct.
  
  
  CONCLUSIONS
  Achilles repair with an added nonabsorbable, high-tensile strength tape allowed for a stronger construct that may allow for a more aggressive, early rehabilitation protocol and earlier return to function.
authors.affiliation: 1 Steadman Philippon Research Institute, Vail, CO, USA.|2 Cornerstone Orthopaedics, Louisville, CO, USA.
authors.forename: Jonathon D
authors.initials: JD
authors.lastname: Backus
authors.affiliation: 1 Steadman Philippon Research Institute, Vail, CO, USA.
authors.forename: Daniel Cole
authors.initials: DC
authors.lastname: Marchetti
authors.affiliation: 1 Steadman Philippon Research Institute, Vail, CO, USA.
authors.forename: Erik L
authors.initials: EL
authors.lastname: Slette
authors.affiliation: 1 Steadman Philippon Research Institute, Vail, CO, USA.
authors.forename: Kimi D
authors.initials: KD
authors.lastname: Dahl
authors.affiliation: 1 Steadman Philippon Research Institute, Vail, CO, USA.
authors.forename: Travis Lee
authors.initials: TL
authors.lastname: Turnbull
authors.affiliation: 1 Steadman Philippon Research Institute, Vail, CO, USA.|3 The Steadman Clinic, Vail, CO, USA.
authors.forename: Thomas O
authors.initials: TO
authors.lastname: Clanton
mesh_terms: D000125:Achilles Tendon / Q000293:injuries / Q000601:surgery*; D001696:Biomechanical Phenomena; D002102:Cadaver; D006801:Humans; D012421:Rupture / Q000601:surgery*; D013536:Suture Techniques; D013537:Sutures / Q000592:standards; D013718:Tensile Strength / Q000502:physiology*
keywords: Achilles repair; acute Achilles ruptures; limited incision repair; sports; tendon disorders