Comparison of Suture Types and Techniques in Achilles Tendon Repair: An Ex Vivo Biomechanical Animal Experiment

Fatih DogarDepartment of Orthopaedics and Traumatology, Kahramanmaras Sutcu Imam University Medical Faculty, 46050 Kahramanmaras, Turkey.

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Kaan GurbuzClinical of Orthopedics and Traumatology, Kayseri City Education & Research Hospital, Kayseri, Turkey.

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Duran TopakDepartment of Orthopaedics and Traumatology, Kahramanmaras Sutcu Imam University Medical Faculty, 46050 Kahramanmaras, Turkey.

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Mustafa Abdullah OzdemirDepartment of Orthopaedics and Traumatology, Kahramanmaras Sutcu Imam University Medical Faculty, 46050 Kahramanmaras, Turkey.

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Burak KuşçuDepartment of Orthopaedics and Traumatology, Kahramanmaras Sutcu Imam University Medical Faculty, 46050 Kahramanmaras, Turkey.

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Yakup EkinciClinical of Orthopedics and Traumatology, Kayseri City Education & Research Hospital, Kayseri, Turkey.

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Sabri BatinClinical of Orthopedics and Traumatology, Kayseri City Education & Research Hospital, Kayseri, Turkey.

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Hakan YaykasliDepartment of Electronics, Elbistan Vocational School of Higher Education, Kahramanmaras Istiklal University, Kahramanmaras, Turkey.

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Okkes BilalDepartment of Orthopaedics and Traumatology, Kahramanmaras Sutcu Imam University Medical Faculty, 46050 Kahramanmaras, Turkey.

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Abstract

Background: Ideal suture technique and type in tendon repair are remain unclear. This biomechanical study aimed to assess the biomechanical characteristics of three techniques, modified Kessler (mKE), modified Krackow (mKR), and modified tension Bunnell (mtBU), in sheep Achilles’ tendon tear repair using three suture types, polypropylene, polyester, and ultra-high molecular weight polyethylene (UHMWPE) sutures, which are also compared.

Methods: Sixty-three Achilles’ tendons harvested from sheep were transversely hacked as a replacement for rupture in a standardized measure and repaired using mKE, mKR, and mtBU techniques with No. 2 polypropylene, polyester, and UHMWPE sutures. Biomechanical parameters, such as Young’s modulus, ultimate strength, and strength to the 5-mm gap were recorded for statistical analysis.

Results: The mtBU technique with UHMWPE use resulted in increased ultimate strength, strenght to 5-mm gap, Young’s modulus, and quantity of specimens with low clinical failure modes compared to other techniques with other suture materials. Furthermore, mtBU has the lowest thickness at the repair side of the tendons. This approach showed tendon failure during maximal traction testing, whereas the mKE and mKR had polyethylene and polyester suture failures.

Conclusions: The UHMWPE suture was significantly superior to the other sutures in each suture techniques in terms of strength and durability. The mtBU technique using UHMWPE suture showed better biomechanical results, implying that this repair might be more appropriate to obtain early mobilization after tendon ruptures.

Corresponding author: Kaan Gurbuz, PhD, MD, Kayseri City Education & Research Hospital, Orthopedics and Traumatology Clinical 3, Şeker Mah. Muhsinyazıcıoğlu Bulvarı No:77, 38080, Kocasinan/Kayseri, Turkey. (E-mail: drkagangurbuz@gmail.com)