TY - JOUR
T1 - Effect of Suture Caliber and Number of Core Strands on Repair of Acute Achilles Ruptures
T2 - A Biomechanical Study
AU - Backus, Jonathon D.
AU - Marchetti, Daniel Cole
AU - Slette, Erik L.
AU - Dahl, Kimi D.
AU - Turnbull, Travis Lee
AU - Clanton, Thomas O.
PY - 2017/5/1
Y1 - 2017/5/1
N2 - 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.6 Results: 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. Clinical Relevance: 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.
AB - 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.6 Results: 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. Clinical Relevance: 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.
KW - Achilles repair
KW - acute Achilles ruptures
KW - limited incision repair
KW - sports
KW - tendon disorders
UR - http://www.scopus.com/inward/record.url?scp=85018968644&partnerID=8YFLogxK
U2 - 10.1177/1071100716687368
DO - 10.1177/1071100716687368
M3 - Article
C2 - 28092968
AN - SCOPUS:85018968644
SN - 1071-1007
VL - 38
SP - 564
EP - 570
JO - Foot and Ankle International
JF - Foot and Ankle International
IS - 5
ER -