title: Suture-Only Repair Versus Suture Anchor-Augmented Repair for Achilles Tendon Ruptures With a Short Distal Stump: A Biomechanical Comparison.
abstract: BACKGROUND
  Chronic noninsertional Achilles tendinosis can result in an acute Achilles tendon rupture with a short distal stump. In such tendon ruptures, there is a limited amount of adequate tissue that can hold suture, thus presenting a challenge for surgeons who elect to treat the rupture operatively.
  
  
  OBJECTIVE
  Adding suture anchors to the repair construct may result in biomechanically stronger repairs compared with a suture-only technique.
  
  
  METHODS
  Controlled laboratory study.
  
  
  METHODS
  Nine paired Achilles-calcaneus complexes were harvested from cadavers. An artificial Achilles rupture was created 2 cm proximal to the insertion on the calcaneus. One specimen from each cadaver was assigned to a suture-only or a suture anchor-augmented repair. The contralateral specimen of the same cadaver received the opposing repair. Cyclic testing was then performed at 10 to 100 N for 2000 cycles, and load-to-failure testing was performed at 0.2 mm/s. This was followed by analysis of repair displacement, gapping at repair site, peak load to failure, and failure mode.
  
  
  RESULTS
  The suture anchor-augmented repair exhibited a 116% lower displacement compared with the suture-only repair (mean ± SD, 1.54 ± 1.13 vs 3.33 ± 1.47 mm, respectively;P< .03). The suture anchor-augmented repair also exhibited a 45% greater load to failure compared with the suture-only repair (303.50 ± 102.81 vs 209.09 ± 48.12 N, respectively;P< .04).
  
  
  CONCLUSIONS
  Suture anchor-augmented repairs performed on acute Achilles tendon ruptures with a short distal stump are biomechanically stronger than suture-only repairs.
  
  
  CONCLUSIONS
  Our results support the use of suture anchor-augmented repairs for a biomechanically stronger construct in Achilles tendon ruptures with a short distal stump. Biomechanically stronger repairs may lead to less tendon repair gapping and failure, increasing the ability to start early active rehabilitation protocols and thus improving patient outcomes.
authors.affiliation: Department of Orthopaedic Surgery, Wright State University, Dayton, Ohio, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Boin
authors.affiliation: Department of Orthopaedic Surgery, Wright State University, Dayton, Ohio, USA.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Dorweiler
authors.affiliation: Department of Orthopaedic Surgery, Wright State University, Dayton, Ohio, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: McMellen
authors.affiliation: Department of Orthopaedic Surgery, Wright State University, Dayton, Ohio, USA.
authors.forename: Gregory C
authors.initials: GC
authors.lastname: Gould
authors.affiliation: Department of Orthopaedic Surgery, Wright State University, Dayton, Ohio, USA.
authors.forename: Richard T
authors.initials: RT
authors.lastname: Laughlin
keywords: Achilles rupture; noninsertional Achilles tendinosis; repair; suture anchor