Jigless Knotless Internal Brace Versus Other Minimal Invasive Achilles Tendon Repair Techniques in Biomechanical Testing Simulating the Progressive Rehabilitation Protocol

Po-Yen Ko; Chieh-Hsiang Hsu; Chih-Kai Hong; Ming-Tung Hung; Wei-Ren Su; I-Ming Jou; Po-Ting Wu; Fong-Chin Su

doi:10.1053/j.jfas.2022.03.014

Jigless Knotless Internal Brace Versus Other Minimal Invasive Achilles Tendon Repair Techniques in Biomechanical Testing Simulating the Progressive Rehabilitation Protocol

J Foot Ankle Surg. 2023 Jan-Feb;62(1):61-67. doi: 10.1053/j.jfas.2022.03.014. Epub 2022 Apr 3.

Authors

Po-Yen Ko¹, Chieh-Hsiang Hsu², Chih-Kai Hong³, Ming-Tung Hung⁴, Wei-Ren Su², I-Ming Jou⁵, Po-Ting Wu⁶, Fong-Chin Su⁷

Affiliations

¹ Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Department of Orthopedics, National Cheng Kung University Hospital, Tainan, Taiwan.
² Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan.
³ Department of Orthopedics, National Cheng Kung University Hospital, Tainan, Taiwan.
⁴ GEG Orthopedic Clinic, Tainan, Taiwan.
⁵ Departments of Orthopedic Surgery and Pathology, E-Da Hospital, I-Shou University, Yen-Chao District, Kaohsiung, Taiwan; GEG Orthopedic Clinic, Tainan, Taiwan.
⁶ Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Department of Orthopedics, National Cheng Kung University Hospital, Tainan, Taiwan. Electronic address: anotherme500@gmail.com.
⁷ Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan. Electronic address: fcsu@ncku.edu.tw.

PMID: 35477848
DOI: 10.1053/j.jfas.2022.03.014

Abstract

The jigless knotless internal brace surgery (JKIB), an alternative method for minimal invasive surgery (MIS) repair of acute Achilles tendon rupture, has advantages of preventing sural-nerve injury in MIS and superficial wound infection in open surgery, as previous clinical research demonstrates. However, no comparative study on the biomechanical performance between JKIB and other MIS techniques has been reported until now. In this study, 50 fresh porcine Achilles tendons were used to compare the JKIB with open surgery (two-stranded Krachow suture) with other MIS techniques, including Percutaneus Achilles Repair System (PARS), Speedbridge (SB), and Achillon Achilles Tendon Suture System (ACH), using a biomechanical testing with cyclic loading at 1 Hz. This test was used to simulate a progressive rehabilitation protocol where 20 to 100 N was applied in the first 250 cycles, followed by 20 to 190 N in the second 250 cycles, and then 20 to 369 N in the third 250 cycles. The cyclic displacement after 10, 100 and 250 cycles were recorded. The survived cycles were defined as a sudden drop in measured load. In survived cycles, the JKIB group (552.3 ± 72.8) had significantly higher cycles than the open, PARS, and ACH groups (204.3 ± 33.3, 395.9 ± 96.0, and 397.1 ± 80.9, respectively, p < .01) as analyzed by post hoc analysis, but no significant difference as compared with the SB group (641.6 ± 48.7). In cyclic displacement after 250 cyclic loadings, the JKIB group (11.29 ± 1.29) showed no significant difference as compared with PARS, SB, and ACH groups (12.21 ± 1.18, 9.80 ± 0.80, and 11.57 ± 1.10 mm, respectively) and significant less displacement than the open group (14.50 ± 1.85, p < .01). These findings suggest that JKIB could be an option for acute Achilles tendon repair in the MIS fashion due to no larger cyclic elongation compared with other MIS techniques.

Keywords: Achilles tendon rupture; Achillon; Krackow suture; Speedbridge; biomechanical study; jigless knotless internal brace; minimally invasive.

MeSH terms

Achilles Tendon* / injuries
Achilles Tendon* / surgery
Animals
Biomechanical Phenomena
Plastic Surgery Procedures*
Rupture / surgery
Suture Techniques
Swine
Tendon Injuries* / surgery