Suture-Only Repair Versus Suture AnchorAugmented Repair for Achilles Tendon Ruptures With a Short Distal Stump A Biomechanical Comparison

Background: 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. Hypothesis: Adding suture anchors to the repair construct may result in biomechanically stronger repairs compared with a suture-only technique. Study Design: Controlled laboratory study. Methods: 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-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. Results: The suture anchor-augmented repair exhibited a 116% lower displacement compared with the suture-only repair (mean +/- SD, 1.54 +/- 1.13 vs 3.33 +/- 1.47 mm, respectively; P < .03). The suture anchor-augmented repair also exhibited a 45% greater load to failure compared with the suture-only repair (303.50 +/- 102.81 vs 209.09 +/- 48.12 N, respectively; P < .04). Conclusion: Suture anchor-augmented repairs performed on acute Achilles tendon ruptures with a short distal stump are biomechanically stronger than suture-only repairs.