TA Rupture Assessment Analysis – are Our "GOLD-Standards“ of Tendon Repair Valid?

Background: Current studies showed that operative treatment has advantages in comparison to conservative treatment for acute Achilles tendon ruptures. The gold standard therapy in our clinic is the operative treatment with the four strand Adelaide suture. The goal of this study is to evaluate which suture material (a) B Braun; MonoMax, b) Ethicon; PDS CTX) is more appropriate for Achilles tendon suture.Methods: Ten pairs of fresh frozen Achilles tendons were obtained from human donors aged 41 – 85. The tendons were fixed on a testing machine and loaded until failure. The goal of this setup was to create a natural rupture pattern. The ruptured tendons were sutured either with BB or PDS and again loaded until failure.The failure mode in all sutured tendons was a pullout of the suture material through the tendon fibres.Results: The ruptures occurred on different locations. The maximal forces in the sutured tendons occurring at the rupture were for the BB-suture between 144 N and 232 N (Mean 197 (SD 67) N) and for the PDS-suture between 158 N and 226 N (Mean 194(SD 70) N). The failure mode in all sutured tendons was a pullout of the suture material through the tendon fibres.Conclusion: Due to the failure mode we are not able to evaluate which suture material is better to use for the Achilles tendon repair with the Adelaide suture. Either the Adelaide suture is not an appropriate suture technique for Achilles tendon repair or the natural rupture pattern has in comparison to the in vitro rupture patterns constructed by sharp dissection a bigger influence on the pullout strength of suture techniques than we thought. This would mean that probably the data from most in vitro studies are not applicable for daily life.