A Biomechanical Study of Achilles Tendon Repair Augmentation Using GraftJacket Matrix

Background: Ruptured Achilles tendons benefit from primary repair by decreasing re-rupture rates and allowing earlier range of motion. A stronger repair might allow for more aggressive rehabilitation decreasing postoperative stiffness, calf atrophy, and repair site gapping. The hypothesis of this study was that human dermal allograft augmentation of an Achilles repair would significantly increase repair strength and stiffness. This study evaluated strength and stiffness of an Achilles tendon repair augmented with a human dermal allograft (GraftJacket). Materials and Methods: Eight matched pairs of human cadaver legs were used. Simulated Achilles tendon ruptures were created 4 cm proximal to the calcaneal insertion. All tendons were repaired with a Krackow locking loop stitch. One of each matched pair was augmented with GraftJacket. Each construct was pre-loaded at 10 N and cyclically loaded (20 cycles) from 2 N to 30 N at a rate of 5 N/sec on an Instron machine. This was followed by testing to failure at a displacement rate of 6 mm/sec. Results: The ultimate failure load in the control group was 217 N ± 31 compared to 455 N ± 76.5 in the GraftJacket group ( p < 0.001). The mean stiffness in the control group was 4.3 ± 0.83 N/mm which was significantly less than the 12.99 ± 5.34 N/mm in the GraftJacket group ( p = 0.002). Conclusion: The augmentation of an Achilles tendon repair with GraftJacket significantly increased repair strength and stiffness. Clinical Significance: These findings suggest that a GraftJacket augmented Achilles tendon repair could acutely withstand a more aggressive rehabilitation program, potentially decreasing ankle stiffness and allowing earlier return to full activities.

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Achilles tendon repair: Achillon system vs. Krackow suture: An anatomic in vitro biomechanical study

Clinical Biomechanics ◽

10.1016/j.clinbiomech.2008.05.007 ◽

2008 ◽

Vol 23 (9) ◽

pp. 1158-1164 ◽

Cited By ~ 33

Author(s):

B. Huffard ◽

P.F. O’Loughlin ◽

T. Wright ◽

J. Deland ◽

J.G. Kennedy

Keyword(s):

Achilles Tendon ◽

Tendon Repair ◽

Biomechanical Study ◽

Achilles Tendon Repair ◽

Krackow Suture

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High-Volume and Privately Owned Ambulatory Surgical Centers Reduce Costs in Achilles Tendon Repair

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120912398 ◽

2020 ◽

Vol 8 (4) ◽

pp. 232596712091239

Author(s):

Lambert T. Li ◽

Carlin Chuck ◽

Steven L. Bokshan ◽

Ryan O’Donnell ◽

Raymond Y. Hsu ◽

...

Keyword(s):

Achilles Tendon ◽

Primary Repair ◽

Statistical Significance ◽

Univariate Analysis ◽

Tendon Repair ◽

Cost Savings ◽

High Volume ◽

Achilles Tendon Repair ◽

Ambulatory Surgical Centers ◽

Privately Owned

Background: While Achilles tendon repairs are common, little data exist characterizing the cost drivers of this surgery. Purpose: To examine cases of primary Achilles tendon repair, primary repair with graft, and secondary repair to find patient characteristics and surgical variables that significantly drive costs. Study Design: Economic and decision analysis; Level of evidence, 3. Methods: A total of 5955 repairs from 6 states were pulled from the 2014 State Ambulatory Surgery and Services Database under the Current Procedural Terminology codes 27650, 27652, and 27654. Cases were analyzed under univariate analysis to select the key variables driving cost. Variables deemed close to significance ( P < .10) were then examined under generalized linear models (GLMs) and evaluated for statistical significance ( P < .05). Results: The average cost was $14,951 for primary repair, $23,861 for primary repair with graft, and $20,115 for secondary repair ( P < .001). In the GLMs, high-volume ambulatory surgical centers (ASCs) showed a cost savings of $16,987 and $2854 in both the primary with graft and secondary repair groups, respectively (both P < .001). However, for primary repairs, high-volume ASCs had $2264 more in costs than low-volume ASCs ( P < .001). In addition, privately owned ASCs showed cost savings compared with hospital-owned ASCs for both primary Achilles repair ($2450; P < .001) and primary repair with graft ($11,072; P = .019). Time in the operating room was also a significant cost, with each minute adding $36 of cost in primary repair and $31 in secondary repair (both P < .001). Conclusion: Private ASCs are associated with lower costs for patients undergoing primary Achilles repair, both with and without a graft. Patients undergoing the more complex secondary and primary with graft Achilles repairs had lower costs in facilities with greater caseload.

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Suturing Achilles tendon and mesh simultaneously in augmented repair resists gap formation foremost: an experimental study

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-019-1390-8 ◽

2019 ◽

Vol 14 (1) ◽

Author(s):

William McCartney ◽

Ciprian Ober ◽

Maria Benito ◽

Bryan MacDonald

Keyword(s):

Achilles Tendon ◽

Polypropylene Mesh ◽

Tendon Repair ◽

Biomechanical Properties ◽

In Vivo Studies ◽

Control Group ◽

Gap Formation ◽

Achilles Tendon Repair ◽

Mesh Augmentation

Abstract Background The common calcanean tendon (Achilles tendon) is the strongest and largest tendon and is one of the most commonly affected by spontaneous rupture. Different suture techniques are used to repair the tendon rupture. We compare the biomechanical properties of three different modalities of suture pattern in a mechanical experiment in rabbits with the purpose of evaluating the use of polypropylene mesh augmentation for Achilles tendon repair to find out the best surgical option. Methods The study tests single cycle to failure tensile strength characteristics of three different combinations of the 3-loop pulley (3-LP) suture technique with polypropylene mesh, and statistically compares the biomechanical properties as the maximum load at failure for all 3-LP repair. Results The normal Achilles tendon—control group—failed at a mean load of 25.5 + 13.6; the experimental groups failed at a significantly lower load (p < 0.001), with the group of 3-LP suture with polypropylene mesh included in the suture being the more similar to controls, but all the groups exhibited statistically significant differences with regard to normal tendons (p < 0.001). The distance at which each group failed was also significant between control and experimental groups (p < 0.001) with the exception of the suture-only group and the group with the mesh over the suture (p = 0.15). Conclusion Results from this study suggest that incorporating the mesh within the suture provides benefit to the Achilles tendon repair by improving strength and resistance to pull through. However, further in vivo studies will be necessary to confirm these results and incorporate this technique to the routine human and veterinary surgery.

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Complications of Supine Surgical Achilles Tendon Repair

Foot & Ankle International ◽

10.1177/1071100718755474 ◽

2018 ◽

Vol 39 (6) ◽

pp. 720-724 ◽

Cited By ~ 4

Author(s):

John J. Marcel ◽

Katherine Sage ◽

Gregory P. Guyton

Keyword(s):

Achilles Tendon ◽

Supine Position ◽

Primary Repair ◽

Tendon Repair ◽

Case Series ◽

Neurologic Complication ◽

Complication Rates ◽

Achilles Tendon Repair ◽

Concomitant Surgery ◽

Tendon Surgery

Background: Open Achilles tendon surgery with the patient in the supine position potentially avoids the complications of the prone position, but the safety and viability of the supine position for this procedure are not known. The aim of this study was to test the hypothesis that supine positioning for open repair of acute Achilles tendon ruptures would be safe, with low wound and neurologic complication rates. Methods: Supine position safety in acute Achilles tendon repair was investigated. Consecutive cases of supine Achilles tendon surgical repair performed by one surgeon from 2010 to 2015 were retrospectively reviewed. Patients were included if they were surgically treated with primary repair in the supine position within 15 days of injury and did not undergo concomitant surgery. A paramedian incision 1 cm medial to the Achilles sheath was used. Initial chart review identified 161 patients who underwent any type of Achilles tendon surgery in the supine position, of whom 45 patients met the inclusion criteria. This group included 39 men and 6 women with an average age of 41 years (range, 20–66 years). Median length of follow-up was 116 days (range, 25–1,589 days). Average body mass index was 29 kg/m2 (range, 23–36 kg/m2). Results: There were no infections, sural nerve injuries, or reruptures. Conclusions: The supine position was safe for primary open Achilles tendon repair, with no wound or neurologic complications. Level of Evidence: Level IV, case series.

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Core Weave Versus Krackow Technique for Achilles Tendon Repair: A Biomechanical Study

Foot & Ankle International ◽

10.3113/fai.2010.1107 ◽

2010 ◽

Vol 31 (12) ◽

pp. 1107-1110 ◽

Cited By ~ 4

Author(s):

Yuhwan Hong ◽

Luis Hermida ◽

Kacey L. White ◽

Brent G. Parks ◽

Lyn M. Camire ◽

...

Keyword(s):

Achilles Tendon ◽

Tendon Repair ◽

Biomechanical Study ◽

Achilles Tendon Repair

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Clinical Tip: Achilles Tendon Repair with Accelerated Rehabilitation Program

Foot & Ankle International ◽

10.1177/107110070502600514 ◽

2005 ◽

Vol 26 (5) ◽

pp. 412-415 ◽

Cited By ~ 3

Author(s):

Ernest Schilders ◽

Quamar Bismil ◽

Robert Metcalf ◽

Hans Marynissen

Keyword(s):

Achilles Tendon ◽

Tendon Repair ◽

Rehabilitation Program ◽

Achilles Tendon Repair ◽

Accelerated Rehabilitation

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Jigless knotless internal brace versus other open Achilles tendon repair under progressive rehabilitation protocol: A biomechanical study

10.21203/rs.3.rs-418074/v1 ◽

2021 ◽

Author(s):

Po-Yen Ko ◽

Chieh-Hsiang Hsu ◽

Chih-Kai Hong ◽

Ming-Tung Hung ◽

I-Ming Jou ◽

...

Keyword(s):

Achilles Tendon ◽

Open Surgery ◽

Biomechanical Testing ◽

Tendon Repair ◽

Tendon Injury ◽

Biomechanical Study ◽

Rehabilitation Protocol ◽

Achilles Tendon Repair ◽

Significant Difference ◽

Internal Brace

Abstract Background The jigless knotless internal brace surgery (JKIB), a modified minimal invasive surgery (MIS) for acute Achilles tendon injury, showed the advantage of sural-nerve injury prevention in MIS and superficial wound infection in open surgery in previous clinical research. However, to date, biomechanical testing remains not yet validated. Materials and methods Sixty porcine fresh Achilles tendons were used to compare the JKIB with other open surgery techniques, the four-strand Krackow suture (4sK) and triple-buddle suture (TBS) in biomechanic testing with cyclic loading at 1 Hz. This approach simulated a progressive rehabilitation protocol where 20-100N was applied in the first 1000 cycles, followed by 20-190N in the second 1000 cycles, and then 20-369N in the third 1000 cycles. The cycles to the repair gap 2mm, 5mm and 10mm were recorded. The survival cycles was defined as repair gap achieving 10mm. Results With respect to survived cycles, a significant difference was found among the three groups, in which the TBS was the most robust, followed by the JKIB and the 4sK, with mean survived cycles were 2639.3 +/- 263.55, 2073.6 +/- 319.92 and 1425.25 +/- 268.96, respectively. Significant difference was defined via a post hoc analysis with the Mann–Whitney U test after the Bonferroni correction (p < 0.017). Conclusions The TBS was the strongest suture structure in acute Achilles tendon repair. However, the JKIB could be an option in acute Achilles tendon repair with the MIS technique due to it being more robust than the 4sK, which has been favored in open repair.

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Biomechanical Effects of Δ9-Tetrahydrocannabinol (THC) and Cannabidiol (CBD), the Major Constituents of Cannabis, in a Sprague Dawley Rat Achilles Tendon Surgical Repair Model: A Pilot Study

The American Journal of Sports Medicine ◽

10.1177/03635465211016840 ◽

2021 ◽

pp. 036354652110168

Author(s):

Christopher M. Stauch ◽

Brittany Ammerman ◽

Diana Sepulveda ◽

Michael C. Aynardi ◽

Matthew R. Garner ◽

...

Keyword(s):

Pilot Study ◽

Achilles Tendon ◽

Tendon Repair ◽

Tendon Healing ◽

Tensile Load ◽

Control Group ◽

Sprague Dawley ◽

Load To Failure ◽

Strength And Stiffness ◽

Opioid Medications

Background: The use of cannabis is common among athletes and the US population at large. Cannabinoids are currently being evaluated as alternatives to opioid medications for chronic pain management. However, the effects of recreational and/or medical use of delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) on musculoskeletal injury and healing remain largely unknown. Hypothesis/Purpose: The purpose of this study was to evaluate the biomechanical effects of CBD and THC on tendon-to-tendon healing in a rat Achilles tendon repair model. The hypothesis was that rats administered CBD would demonstrate decreased tensile load to failure of surgically repaired Achilles tendons compared with the THC and control groups. Study Design: Controlled laboratory study. Methods: A total of 33 Sprague Dawley rats underwent Achilles tendon surgical transection and repair and were randomized to receive subcutaneous injection of THC, CBD, or vehicle once daily starting on the day of surgery and for 5 total days. After sacrifice, biomechanical tensile load-displacement testing was performed to determine Achilles tendon load to failure and stiffness. Data were analyzed by 1-way analysis of variance. Results: The THC group demonstrated the highest median load to failure, 18.7 N (95% CI, 15.3-19.2 N); the CBD group had the second highest at 16.9 N (95% CI, 15.1-19.8 N), and the control group had the lowest at 14.4 N (95% CI, 12.1-18.3 N). Stiffness was highest in the THC group at 4.1 N/mm (95% CI, 2.7-5.1 N/mm) compared with 3.6 N/mm (95% CI, 2.9-4.1 N/mm) for the CBD group and 3.6 N/mm (95% CI, 2.8-4.3 N/mm) for the control group. No statistically significant differences for strength and stiffness were observed between the groups. Conclusion: In this pilot study using an animal tendon-to-tendon repair model, neither THC nor CBD resulted in altered biomechanical characteristics compared to control. Clinical Relevance: Cannabinoids do not appear to adversely affect Achilles tendon healing.

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