Abstract
Tendon elongation after Achilles tendon (AT) repair is associated with the clinical outcome. Reliable suture techniques are essential to reduce gap formations and to allow early mobilization. Cyclic loading conditions represent the repetitive loading in rehabilitation. The aim of this study was to compare the Kessler stitch and double loop knot stitch (DLKS) in a cyclic loading program focussing on gap formation. Sixteen human cadaveric ATs were transected and sutured using either the Kessler stitch or DLKS (eight matched pairs). The suture-tendon configurations were subjected to cyclic loading and additional ultimate load to failure testing using the Zwick 1446 universal testing machine. Each AT survived cyclic loading, with a mean gap formation less than 5 mm after 1000 cycles. The mechanical properties of the Kessler stitch and DLKS were not significantly different after cyclic loading with a mean displacement of 4.57 mm (± 1.16) for the Kessler stitch and 4.85 mm (± 1.14) for the DLKS (P = .76). There were no significant differences in the ultimate load testing (P = .85). Both bioprotective techniques prevent excessive gaping in cyclic testing when tendon loading is moderate. Our data and those from literature of gap formation in cyclic and ultimate loading allow the conclusion, that early aggressive AT loading after repair (e.g. full weightbearing) overstrain simple as well as complex suture configurations. Initial intraoperative tightening of the knots (preloading) before locking is important to decrease postoperative elongation.
Highlights
The Achilles tendon (AT) is the most frequently ruptured tendon, with increasing incidence [1, 2]
An additional visual and palpatory examination of the Achilles tendon was performed to confirm the integrity of the tendon and to rule out possible damage to the tendons
In the Kessler group, the failure modes at ultimate loading were suture rupture and pull out of the suture
Summary
The Achilles tendon (AT) is the most frequently ruptured tendon, with increasing incidence [1, 2]. AT rupture commonly occurs during sports activities in males during their third or fourth decades (i.e., “weekend warriors”) [2, 3]. After AT rupture, patients often do not recover full strength and function, even after extended rehabilitation [4,5,6]. Strength and functional outcome are key issues in treatment, the re-rupture rate is commonly the main variable for assessing the success of treatment.
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