A Biomechanical Comparison of Limited Open Versus Krackow Repair for Achilles Tendon Rupture
Background: Soft tissue complications after Achilles tendon repair has led to increased interest in less invasive techniques. Various limited open techniques have gained popularity as an alternative to open operative repair. The purpose of this study was to biomechanically compare an open Krackow an...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2017-10-01
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| Series: | Foot & Ankle Orthopaedics |
| Online Access: | https://doi.org/10.1177/2473011417715431 |
| _version_ | 1818504654473920512 |
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| author | Robert G. Dekker MD Charles Qin BA Cort Lawton MD Muturi G. Muriuki PhD Robert M. Havey MS Mohammed Alshouli MD Avinash G. Patwardhan PhD Anish Kadakia MD |
| author_facet | Robert G. Dekker MD Charles Qin BA Cort Lawton MD Muturi G. Muriuki PhD Robert M. Havey MS Mohammed Alshouli MD Avinash G. Patwardhan PhD Anish Kadakia MD |
| author_sort | Robert G. Dekker MD |
| collection | DOAJ |
| description | Background: Soft tissue complications after Achilles tendon repair has led to increased interest in less invasive techniques. Various limited open techniques have gained popularity as an alternative to open operative repair. The purpose of this study was to biomechanically compare an open Krackow and limited open repair for Achilles tendon rupture. We hypothesized that there would be no statistical difference in load to failure, work to failure, and initial linear stiffness. Methods: A simulated Achilles tendon rupture was created 4 cm proximal to its insertion in 18 fresh-frozen cadaveric below-knee lower limbs. Specimens were randomized to open or limited open PARS Achilles Jig System repair. Repairs were loaded to failure at a rate of 25.4 mm/s to reflect loading during normal ankle range of motion. Load to failure, work to failure, and initial linear stiffness were compared between the 2 repair types. Results: The average load to failure (353.8 ± 88.8 N vs 313.3 ± 99.9 N; P = .38) and work to failure (6.4 ± 2.3 J vs 6.3 ± 3.5 J; P = .904) were not statistically different for Krackow and PARS repair, respectively. Mean initial linear stiffness of the Krackow repair (17.8 ± 5.4 N/mm) was significantly greater than PARS repair (11.8 ± 2.5 N/mm) ( P = .011). Conclusion: No significant difference in repair strength was seen, but higher initial linear stiffness for Krackow repair suggests superior resistance to gap formation, which may occur during postoperative rehabilitation. With equal repair strength, but less soft tissue devitalization, the PARS may be a favorable option for patients with risk factors for soft tissue complications. |
| first_indexed | 2024-12-10T21:40:00Z |
| format | Article |
| id | doaj.art-c26c776832e74f98bb1d5c4bfd636dc4 |
| institution | Directory Open Access Journal |
| issn | 2473-0114 |
| language | English |
| last_indexed | 2024-12-10T21:40:00Z |
| publishDate | 2017-10-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Foot & Ankle Orthopaedics |
| spelling | doaj.art-c26c776832e74f98bb1d5c4bfd636dc42022-12-22T01:32:31ZengSAGE PublishingFoot & Ankle Orthopaedics2473-01142017-10-01210.1177/2473011417715431A Biomechanical Comparison of Limited Open Versus Krackow Repair for Achilles Tendon RuptureRobert G. Dekker MD0Charles Qin BA1Cort Lawton MD2Muturi G. Muriuki PhD3Robert M. Havey MS4Mohammed Alshouli MD5Avinash G. Patwardhan PhD6Anish Kadakia MD7Department of Orthopaedic Surgery, Northwestern University, Chicago, IL, USAFeinberg School of Medicine, Northwestern University, Chicago, IL, USADepartment of Orthopaedic Surgery, Northwestern University, Chicago, IL, USAMusculoskeletal Biomechanics Laboratory, Edward Hines Jr. VA Hospital, Hines, IL, USADepartment of Orthopaedic Surgery and Rehabilitation, Loyola University Chicago, Maywood, IL, USADepartment of Orthopaedic Surgery, Northwestern University, Chicago, IL, USADepartment of Orthopaedic Surgery and Rehabilitation, Loyola University Chicago, Maywood, IL, USADepartment of Orthopaedic Surgery, Northwestern University, Chicago, IL, USABackground: Soft tissue complications after Achilles tendon repair has led to increased interest in less invasive techniques. Various limited open techniques have gained popularity as an alternative to open operative repair. The purpose of this study was to biomechanically compare an open Krackow and limited open repair for Achilles tendon rupture. We hypothesized that there would be no statistical difference in load to failure, work to failure, and initial linear stiffness. Methods: A simulated Achilles tendon rupture was created 4 cm proximal to its insertion in 18 fresh-frozen cadaveric below-knee lower limbs. Specimens were randomized to open or limited open PARS Achilles Jig System repair. Repairs were loaded to failure at a rate of 25.4 mm/s to reflect loading during normal ankle range of motion. Load to failure, work to failure, and initial linear stiffness were compared between the 2 repair types. Results: The average load to failure (353.8 ± 88.8 N vs 313.3 ± 99.9 N; P = .38) and work to failure (6.4 ± 2.3 J vs 6.3 ± 3.5 J; P = .904) were not statistically different for Krackow and PARS repair, respectively. Mean initial linear stiffness of the Krackow repair (17.8 ± 5.4 N/mm) was significantly greater than PARS repair (11.8 ± 2.5 N/mm) ( P = .011). Conclusion: No significant difference in repair strength was seen, but higher initial linear stiffness for Krackow repair suggests superior resistance to gap formation, which may occur during postoperative rehabilitation. With equal repair strength, but less soft tissue devitalization, the PARS may be a favorable option for patients with risk factors for soft tissue complications.https://doi.org/10.1177/2473011417715431 |
| spellingShingle | Robert G. Dekker MD Charles Qin BA Cort Lawton MD Muturi G. Muriuki PhD Robert M. Havey MS Mohammed Alshouli MD Avinash G. Patwardhan PhD Anish Kadakia MD A Biomechanical Comparison of Limited Open Versus Krackow Repair for Achilles Tendon Rupture Foot & Ankle Orthopaedics |
| title | A Biomechanical Comparison of Limited Open Versus Krackow Repair for Achilles Tendon Rupture |
| title_full | A Biomechanical Comparison of Limited Open Versus Krackow Repair for Achilles Tendon Rupture |
| title_fullStr | A Biomechanical Comparison of Limited Open Versus Krackow Repair for Achilles Tendon Rupture |
| title_full_unstemmed | A Biomechanical Comparison of Limited Open Versus Krackow Repair for Achilles Tendon Rupture |
| title_short | A Biomechanical Comparison of Limited Open Versus Krackow Repair for Achilles Tendon Rupture |
| title_sort | biomechanical comparison of limited open versus krackow repair for achilles tendon rupture |
| url | https://doi.org/10.1177/2473011417715431 |
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