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Biomechanical properties of double- and single-row suture anchor repair for surgical treatment of insertional Achilles tendinopathy.

Publication ,  Journal Article
Beitzel, K; Mazzocca, AD; Obopilwe, E; Boyle, JW; McWilliam, J; Rincon, L; Dhar, Y; Arciero, RA; Amendola, A
Published in: Am J Sports Med
July 2013

BACKGROUND: Because of intratendinous ossifications, retrocalcaneal bursitis, or intratendinous necrosis commonly found in insertional tendinosis, it is often necessary to detach the tendon partially or entirely from its tendon-to-bone junction. HYPOTHESIS: Double-row repair for insertional Achilles tendinopathy will generate an increased contact area and demonstrate higher biomechanical stability. STUDY DESIGN: Controlled laboratory study. METHODS: Eighteen cadaver Achilles tendons were split longitudinally and detached, exposing the calcaneus; an ostectomy was performed and the tendon was reattached to the calcaneus in 1 of 2 ways: 2 suture anchors (single row) or a 4-anchor (double row) construct. Footprint area measurements over time, displacement after cyclic loading (2000 cycles), and final load to failure were measured. RESULTS: The double-row refixation technique was statistically superior to the single-row technique in footprint area measurement initially and 5 minutes after repair (P = .009 and P = .01, respectively) but not after 24 hours (P = .713). The double-row construct demonstrated significantly improved measures for peak load (433.9 ± 84.3 N vs 212.0 ± 49.7 N; P = .042), load at yield (354.7 ± 106.2 N vs 198.7 ± 39.5 N; P = .01), and slope (51.8 ± 9.9 N/mm vs 66.7 ± 16.2 N/mm; P = .021). Cyclic loading did not demonstrate significant differences between the 2 constructs. CONCLUSION: Double-row construct for reinsertion of a completely detached Achilles tendon using proximal and distal rows resulted in significantly larger contact area initially and 5 minutes after repair and led to significantly higher peak load to failure on destructive testing. CLINICAL RELEVANCE: In treatment for insertional Achilles tendinosis, the tendon often has to be detached and anatomically reattached to its insertion at the calcaneus. To our knowledge there is a lack of biomechanical studies supporting either a number or a pattern of suture anchor fixation. Because the stresses going across the insertion site of the Achilles tendon are significant during rehabilitation and weightbearing activities, it is imperative to have a strong construct that allows satisfactory healing during the early postoperative process.

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Published In

Am J Sports Med

DOI

EISSN

1552-3365

Publication Date

July 2013

Volume

41

Issue

7

Start / End Page

1642 / 1648

Location

United States

Related Subject Headings

  • Weight-Bearing
  • Tendinopathy
  • Suture Techniques
  • Pressure
  • Orthopedics
  • Middle Aged
  • Male
  • Humans
  • Female
  • Adult
 

Citation

APA
Chicago
ICMJE
MLA
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Beitzel, K., Mazzocca, A. D., Obopilwe, E., Boyle, J. W., McWilliam, J., Rincon, L., … Amendola, A. (2013). Biomechanical properties of double- and single-row suture anchor repair for surgical treatment of insertional Achilles tendinopathy. Am J Sports Med, 41(7), 1642–1648. https://doi.org/10.1177/0363546513487061
Beitzel, Knut, Augustus D. Mazzocca, Elifho Obopilwe, James W. Boyle, James McWilliam, Lina Rincon, Yasmin Dhar, Robert A. Arciero, and Annunziato Amendola. “Biomechanical properties of double- and single-row suture anchor repair for surgical treatment of insertional Achilles tendinopathy.Am J Sports Med 41, no. 7 (July 2013): 1642–48. https://doi.org/10.1177/0363546513487061.
Beitzel K, Mazzocca AD, Obopilwe E, Boyle JW, McWilliam J, Rincon L, et al. Biomechanical properties of double- and single-row suture anchor repair for surgical treatment of insertional Achilles tendinopathy. Am J Sports Med. 2013 Jul;41(7):1642–8.
Beitzel, Knut, et al. “Biomechanical properties of double- and single-row suture anchor repair for surgical treatment of insertional Achilles tendinopathy.Am J Sports Med, vol. 41, no. 7, July 2013, pp. 1642–48. Pubmed, doi:10.1177/0363546513487061.
Beitzel K, Mazzocca AD, Obopilwe E, Boyle JW, McWilliam J, Rincon L, Dhar Y, Arciero RA, Amendola A. Biomechanical properties of double- and single-row suture anchor repair for surgical treatment of insertional Achilles tendinopathy. Am J Sports Med. 2013 Jul;41(7):1642–1648.
Journal cover image

Published In

Am J Sports Med

DOI

EISSN

1552-3365

Publication Date

July 2013

Volume

41

Issue

7

Start / End Page

1642 / 1648

Location

United States

Related Subject Headings

  • Weight-Bearing
  • Tendinopathy
  • Suture Techniques
  • Pressure
  • Orthopedics
  • Middle Aged
  • Male
  • Humans
  • Female
  • Adult