Cyclic Loading of Achilles Tendon Repairs: A Comparison of Polyester and Polyblend Suture

Abstract

Background: Early functional rehabilitation is widely used after open suture repair of the Achilles tendon. To our knowledge, no previous studies have assessed gap formation from cyclic loading and subsequent failure loads of simulated Achilles tendon repairs. A synthetic (polyblend) suture has been introduced for tendon repairs with reportedly greater strength than polyester suture. This stronger, stiffer suture material may provide stronger repairs with less elongation of the tendon repair. Methods: Simulated Achilles tendon ruptures in bovine Achilles tendon were repaired with a four-strand Krackow suture technique using No. 2 polyester suture. Specimens were loaded for 3000 cycles at maximal loads of 50, 75,100, or 125 N, and gap formation at the repair site was continuously measured. After cyclic loading, each specimen was loaded to failure. Identical repairs were performed with number 2 polyblend suture and cyclically loaded to 75 N for 3000 cycles. All specimens were loaded to failure. Results: Cyclically loading polyester suture repairs to 50, 75, 100, or 125 N for 3000 cycles resulted in mean gapping at the repair site of 3.0 ± 0.8,4.9 ± 1.0,7.2 ± 0.9, and 7.9 ± 0.8 mm, respectively. Cyclically loading the polyblend suture repairs for 3000 cycles at 75 N, resulted in 3.3 ± 0.3 mm of gap formation at the repair site, significantly less than polyester suture repairs (p < 0.001). The mean load to failure for polyester suture repair was 222 ± 19 N and for polyblend suture repair was 582 ± 49 N, a statistically significant difference (p < 0.001). Gap formation at 100, 1000, and 2000 cycles, as a percentage of total gap formation at 3000 cycles, was 64.3%, 87.5%, and 95.4% for polyester suture and 45.8%, 78.5%, and 90.1% for polyblend repairs. All specimens in all groups failed at the knots during load-to-failure testing. Conclusions: Cyclic loading of simulated Achilles tendon repairs using a Krackow, four-core polyester suture technique showed progressive gap formation with increasing load. All repairs failed at the knot, and suture pull-out from tendon was not observed. Polyblend suture repair, when compared to identical repairs with braided polyester suture, resulted in a 260% higher load to failure and 33% less gap formation at the repair site after 3000 cycles. Clinical Relevance: The use of polyblend suture in a four-stranded Krackow configuration provides stronger repairs with less gap formation, which may provide increased security during early functional rehabilitation.