Suture-Only Repair Versus Suture Anchor–Augmented Repair for Achilles Tendon Ruptures With a Short Distal Stump

<p> <h3 id="x-x-__sec1title"> Background: </h3> <p id="x-x-__p1"> 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. <h3 id="x-x-__sec2title"> Hypothesis: </h3> <p id="x-x-__p2"> Adding suture anchors to the repair construct may result in biomechanically stronger repairs compared with a suture-only technique. <h3 id="x-x-__sec3title"> Study Design: </h3> <p id="x-x-__p3"> Controlled laboratory study. <h3 id="x-x-__sec4title"> Methods: </h3> <p id="x-x-__p4"> 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&ndash;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. <h3 id="x-x-__sec5title"> Results: </h3> <p id="x-x-__p5"> The suture anchor&ndash;augmented repair exhibited a 116% lower displacement compared with the suture-only repair (mean &plusmn; SD, 1.54 &plusmn; 1.13 vs 3.33 &plusmn; 1.47 mm, respectively; <em> P </em> &lt; .03). The suture anchor&ndash;augmented repair also exhibited a 45% greater load to failure compared with the suture-only repair (303.50 &plusmn; 102.81 vs 209.09 &plusmn; 48.12 N, respectively; <em> P </em> &lt; .04). <h3 id="x-x-__sec6title"> Conclusion: </h3> <p id="x-x-__p6"> Suture anchor&ndash;augmented repairs performed on acute Achilles tendon ruptures with a short distal stump are biomechanically stronger than suture-only repairs. <h3 id="x-x-__sec7title"> Clinical Relevance: </h3> <p id="x-x-__p7"> Our results support the use of suture anchor&ndash;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. </p> </p> </p> </p> </p> </p> </p></p>