Homero de Miranda Gomes Regional Hospital, São José, and Adames Central Medic(CMA), Florianópolis, SC, Brazil.
Biomechanichal Engineering Laboratory, University Hospital, Federal University of Santa Catarina, Florianópolis, SC, Brazil.
Injury. 2023 Dec;54(12):111134. doi: 10.1016/j.injury.2023.111134. Epub 2023 Oct 15.
The biomechanical assessment of tendon repair is essential for the evaluation of different tendon suturing techniques. The shoelace suture technique with absorbable Vicryl® is a modified technique of Achilles tendon repair that may have biomechanical advantages depending on the number of threads used and the direction of the suture.
To evaluate the creep under constant pre-load, the stiffness, the maximum strength, and the failure mode for three different configurations of the shoelace suture in a bovine tendon biomechanical model.
Controlled Laboratory Study.
36 bovine Achilles tendon specimens were acquired and divided into three test groups of 12 Achilles tendons each. A model of the calcaneal tendon rupture was created through a transverse cut with a scalpel, performed 5 centimeters proximal to the calcaneal bone insertion. Group 1 was repaired using the simple shoelace technique with just one suture. Group 2 was repaired using the shoelace technique with three sutures individually sutured from distal to proximal at the site of rupture. Group 3 was repaired using the shoelace technique with three sutures individually sutured from proximal to distal at the site of rupture.
System creep after constant pre-load was 5.9 ± 2.5 mm, 3.0 ± 0.4 mm and 2.9 ± 0.4 mm for groups 1, 2 and 3, respectively. The system's stiffness was 23.2 ± 2.8 N/mm, 30.3 ± 1.1 N/mm and 29.8 ± 2.3 N/mm for groups 1, 2 and 3, respectively. In the final load-to-failure test, the ultimate load force (ULF) was 158.2 ± 27.5 N, 346.5 ± 47.6 N and 358.1 ± 41.6 N for groups 1, 2 and 3, respectively. There was statistical significance in the comparative tests between groups 1-2 and 1-3 in terms of means of creep, system stiffness and maximum system strength. No statistically significant difference was found between groups 2 and 3 when analyzing creep, system stiffness and ULF. Suture breakage was the prevalent mode of failure for all tested groups.
The shoelace with three sutures significantly reduced creep in the preloading phase and increased the stiffness and ultimate load force. The biomechanical results demonstrate better overall mechanical performance of the technique than the simple shoelace technique. The better mechanical performance indicates that the shoelace with three sutures could result in early postoperative rehabilitation.
This study indicates that the shoelace suture technique with three sutures is biomechanically strong and stiff, being a possible therapeutic option to be used.
对于不同的肌腱缝合技术，评估肌腱修复的生物力学至关重要。鞋带缝合技术（使用可吸收的 Vicryl®）是一种改良的跟腱修复技术，根据使用的缝线数量和缝线方向的不同，可能具有生物力学优势。
在牛跟腱生物力学模型中，评估三种不同鞋带缝合方式的恒定预载下的蠕变、刚度、最大强度和失效模式。
对照实验室研究。
采集 36 个牛跟腱标本，分为三组，每组 12 个跟腱。通过手术刀进行横切，在距跟骨插入处 5 厘米处创建跟腱断裂模型。第 1 组采用简单的鞋带技术，仅使用一根缝线进行修复。第 2 组采用三根缝线的鞋带技术，每根缝线单独从远到近在断裂处缝合。第 3 组采用三根缝线的鞋带技术，每根缝线单独从近到远在断裂处缝合。
恒定预载后的系统蠕变分别为组 1（5.9±2.5）mm、组 2（3.0±0.4）mm 和组 3（2.9±0.4）mm。系统刚度分别为组 1（23.2±2.8）N/mm、组 2（30.3±1.1）N/mm 和组 3（29.8±2.3）N/mm。在最终的破坏试验中，极限载荷力（ULF）分别为组 1（158.2±27.5）N、组 2（346.5±47.6）N 和组 3（358.1±41.6）N。在组 1-2 和组 1-3 之间的比较测试中，蠕变、系统刚度和最大系统强度的平均值存在统计学意义。在分析蠕变、系统刚度和 ULF 时，组 2 和组 3 之间没有发现统计学差异。缝线断裂是所有测试组的主要失效模式。
三缝线鞋带技术可显著减少预加载阶段的蠕变，增加刚度和极限载荷力。生物力学结果表明，该技术的整体力学性能优于简单的鞋带技术。更好的机械性能表明，三缝线鞋带技术可能会导致术后早期康复。
本研究表明，三缝线鞋带技术具有较强的生物力学性能，坚固而僵硬，是一种可行的治疗选择。
