Laboratory of Biomechanics, Department of Orthopaedics and Orthopaedic Surgery, Justus-Liebig-University Giessen, Klinikstrasse 29, 35392 Giessen, Germany.
Institute of Medical Informatics Medical Statistics, Medical Faculty of Justus Liebig University Giessen, Rudolf-Buchheim-Straße 6, 35392 Giessen, Germany.
J Biomech. 2019 Aug 27;93:132-139. doi: 10.1016/j.jbiomech.2019.06.021. Epub 2019 Jul 2.
Following surgical Achilles tendon reconstruction surgery, there is a distinct trend towards an early and faster rehabilitation protocol to avoid muscle atrophy. However, this procedure involves the risk of a higher complication rate. In order to reduce the occurrence of re-ruptures and pathological tendon extensions, a tendon reconstruction with the highest possible primary stability is desirable. Therefore, the aim of this study was to determine if augmentation using synthetic polyester tapes (QuadsTape™) could provide greater primary stability in case of different tendon suture techniques. 90 tendons of the superficial toe flexor of pigs were divided into 9 groups. The reconstruction method was combined using the factors suture technique (Kessler and Bunnell), augmentation (non-augmented and augmented with QuadsTape™) and defect type (end-to-end and 10 mm gap). The biomechanical measurements were performed on a material testing machine and consisted of a creep test, a cyclic test and a tear-off test. This study compared creep strain, ultimate load failure, maximum stress and stiffness. Irrespective of the type of defect involved, augmentation of the tendon sutures led to a significant increase of the maximum force (not augmented: 82.30 ± 25.48 N, augmented: 135.73 ± 30.69 N, p < 0.001) and the maximum stress (not augmented: 2.26 ± 0.83 MPa, augmented: 4.13 ± 1.79 MPa, p < 0.001). Furthermore, there was a non-significant increase in stiffness and no significant differences were observed with respect to creep strain. Augmentation of Achilles tendon reconstruction using QuadsTape™ increases composite strength and stiffness in the in vitro model, thus potentially contributing to the feasibility of early rehabilitation programs. Biological factors still need to be investigated in order to formulate appropriate indications.
在接受跟腱重建手术后，存在明显的早期和更快康复的趋势，以避免肌肉萎缩。然而，这种手术程序存在更高的并发症风险。为了降低再断裂和病理性跟腱延伸的发生，理想情况下需要进行具有尽可能高的初始稳定性的跟腱重建。因此，本研究旨在确定使用合成聚酯带（QuadsTape™）增强是否可以在不同的肌腱缝合技术中提供更大的初始稳定性。将 90 根猪的浅层趾屈肌腱分为 9 组。重建方法结合了缝合技术（Kessler 和 Bunnell）、增强（未增强和使用 QuadsTape™增强）和缺损类型（端端和 10mm 间隙）这两个因素。生物力学测量在材料试验机上进行，包括蠕变试验、循环试验和撕裂试验。本研究比较了蠕变应变、极限载荷失效、最大应力和刚度。无论涉及哪种类型的缺损，肌腱缝线的增强都导致最大力显著增加（未增强：82.30±25.48N，增强：135.73±30.69N，p<0.001）和最大应力显著增加（未增强：2.26±0.83MPa，增强：4.13±1.79MPa，p<0.001）。此外，刚度略有增加，但蠕变应变没有显著差异。使用 QuadsTape™增强跟腱重建可增加体外模型中的复合强度和刚度，从而为早期康复计划的可行性提供潜在帮助。仍需要研究生物学因素，以制定适当的适应证。
