Clinical failure after Dresden repair of mid-substance Achilles tendon rupture: human cadaveric testing

Abstract

The purpose of this study was to describe the angle of clinical failure during cyclical mobilization exercises in the Achilles tendon of human cadaveric specimens that were repaired using the Dresden technique and FiberWire(A (R)) No. 2. The secondary aim was to identify the secure limit of mobilization, the type of failure, and the type of apposition.

The lower limbs of eight males (mean age: 60.3 +/- 6.3 years) were repaired with the Dresden technique following complete, percutaneous mid-substance Achilles tendon rupture. A basal tension of 10 N at 30A degrees of plantarflexion was placed on each specimen. The angle of the ankle during clinical failure (tendon ends separation > 5 mm) was then tested via cyclical exercises (i.e. 100 cycles between 30A degrees and 15A degrees of plantarflexion; 100 cycles between 15A degrees of plantarflexion and 0A degrees; 100 cycles between 0A degrees and 15A degrees of dorsiflexion; and 100 cycles between 15A degrees of dorsiflexion and full dorsiflexion). Clinical failure was determined using the Laplacian edge detection filter, and the angle of clinical failure was obtained using a rotatory potentiometer aligned in relation to the intermalleolar axis of each foot specimen. The type of failure (knot, tendon, or suture) and apposition (termino-terminal or non-termino-terminal) were determined. Descriptive statistics were used to obtain the mean; standard deviation; 95 % confidence interval; 1st, 25th, 50th, 75th, and 100th percentiles; and the standard error of the mean for angle data. Proportions were used to describe the type of failure and apposition.

The main results were a mean angle of clinical failure equal to 12.5A degrees of plantarflexion, a limit of mobilization equal to 14.0A degrees of plantarflexion, tendon failure type, and non-termino-terminal apposition in all specimens.

While the mean angle of clinical failure in human cadaveric models was 12.5A degrees of plantarflexion, after 14.0A degrees of plantarflexion, the percutaneous Dresden technique was found insecure for cyclical mobilization exercises, with a 5 % range of error. These findings are clinically relevant as they provide mechanical limits for diminishing the risk of Achilles lengthening during immediate rehabilitation.