Epidemiological Characteristics of Patients Operated for Achilles Tendon Rupture in Shanghai

Evaluating barbed sutures: A porcine biomechanical comparison of Z-plasty and turndown flap according to Silfverskiöld

Introduction

It is not possible to add an infinite amount of suture material to tendon plasties and repairs in vivo. Each additional knot can reduce the tensile strength by up to 50 %. Therefore, barbed sutures, as a knotless suturing system, should be investigated as a potential alternative to traditional sutures to minimize knot-related weakening.

Material and methods

Superficial porcine flexors were randomized into five groups. A non-contact measurement was utilized. The Z-plasty and the turndown flap according to Silfverskiöld were used. The Stratafix barbed knotless suture was compared to regular smooth polydioxanone. The biomechanical protocol included a creep test, a cyclic test, and a tear-off test.

Results

The Z-plasty with Stratafix showed significantly improved maximum force compared to the Z-plasty with Polydioxanon (PDS 108.5 ± 22.2N, Stratafix 142.3 ± 23.5N, p < .01). The Z-plasty was significantly superior to the turndown flap in maximum Force (turndownflap with Stratafix 52.4 ± 14.6N, Z-plasty with Stratafix 108.5 ± 22.2N, p < .001).

Conclusion

The Stratafix barbed suture can significantly improve the Z-plasty in maximum tension by up to 32 % when compared to regular PDS. To formulate a more precise indication, biological factors must be further investigated.

Decellularised amniotic membrane-TDSCs composite promotes Achilles tendon healing

Adhesions and poor healing are major complications after Achilles tendon injury, and there is no effective solution to this problem. The purpose of this study is to determine whether the biomimetic peritoneurosis can solve the above problems in the process of Achilles tendon healing; This study investigated the adhesion and proliferation of tendon-derived stem cells (TDSCs) on dAM in vitro, as well as their tenogenic differentiation. The effects of Achilles tendon rupture on tendon regeneration were assessed in vivo by using an Achilles tendon rupture model in rats; Finally, from in vitro mRNA transcriptome sequencing combined with in vivo Achilles tendon protein to omics analysis to explore the repair mechanism of Achilles tendon rupture. Student's t-tests were used to assess the significance of observed differences between the two experimental groups. Multiple groups were compared using one-way analysis of variances (ANOVAs), followed by post hoc Bonferroni comparisons. The main findings of this study are that cell adhesion, proliferation, and differentiation of TDSCs were enhanced by dAM. Implanted dAM + TDSCs significantly accelerated tendon regeneration in vivo. In addition, extracellular matrix-related differential genes and proteins were screened by mRNA transcriptometry in vitro and proteomic analysis of Achilles tendon in vivo, and ERK signaling pathway was further explored to participate in the repair of Achilles tendon rupture. The dAM-TDSCs composite biomimetic peritendinous membrane material can effectively promote the healing of Achilles tendon. It provides a new direction for the development of biomimetic peritendinous membrane materials.

Biomechanical comparison of tendon repair techniques: Bunnell suture leads in mode of failure and minimally invasive configuration in elongation

Purpose

In this experimental study, the Minimally Invasive Configuration (MIC), the Bunnell, Kessler and modified Bunnell-Kessler techniques for tendon rupture repair were compared in terms of the following biomechanical parameters: maximum load, mode of failure, failure elongation, tension/construct elongation and stiffness (Young's modulus). The scope of comparison involves understanding the properties of each suture technique in hopes of eventually contributing to surgical decision-making.

Methods

Thirty-two frozen ovine specimens were obtained, and transverse tenotomy was performed on each. Eight tendons were randomly allocated to each technique. Specimens were tested performing a unidirectional tensile load to failure using a servo-hydraulic testing device. The tendons were also loaded to failure at a rate of 10 mm/s. The total length of the construct was defined as the distance from the two clamps. Stiffness was calculated by determining the slope of the force-displacement curve in the linear region. Total failure was defined as a drop of measured force or rupture of the tendon-suture complex.

Results

In the mode of failure, Tukey's post hoc test showed a statistically significant difference between the Bunnell group and the other three groups (p < 0.05). For Tension/construct elongation at 5 and 10 mm, Tukey's post hoc test showed a statistically significant difference between the MIC group and the other three groups (p < 0.05). At 15 mm Tukey's post hoc test showed a statistically significant difference between the MIC group and the Kessler group (p < 0.05).

Conclusion

The Bunnell suture performed best in terms of mode of failure, while the MIC suture technique outperformed the rest in terms of tension/construct elongation. Findings show sufficient biomechanical evidence to support the ongoing clinical application of all techniques.

Level of Evidence

Level V.

Association between copper and Achilles tendon disease: a two-sample Mendelian randomization study

Background

There is a clear association between micronutrients and Achilles tendon disease (AT). An increase in micronutrients may alleviate AT symptoms and have a therapeutic effect. The aim of this study is to clarify the causal relationship between 15 micronutrients (copper, zinc, magnesium, vitamins A, C, E, D, B6, B12, folic acid, carotene, iron, selenium, calcium, and potassium) and AT.

Methods

We employed the Mendelian randomization (MR) method to analyze the causal effects of micronutrients on the risk of AT. The SNPs related to micronutrients were obtained from a large-scale genome-wide association study (GWAS) of circulating micronutrients in European populations. Outcome data were obtained from a meta-analysis of AT in European-ancestry participants from the Finnish FINNGEN BIOBANK. The main analysis was conducted using the inverse variance weighting (IVW) method, with additional sensitivity and pleiotropy analyses performed.

Results

Inverse variance weighting results indicated a causal relationship between copper and AT (P = 0.003, OR = 0.899, 95% CI = 0.839-0.964). Sensitivity analysis validated the robustness and reliability of this finding.

Conclusion

This study revealed a causal relationship between copper and AT, with copper serving as a protective factor. This provides evidence of the causality between copper and AT, offering new insights for clinical research and therapeutic approaches in AT.

Injectable self-assembled GDF5-containing dipeptide hydrogels for enhanced tendon repair

Owing to the tissue characteristics of tendons with few blood vessels and cells, the regeneration and repair of injured tendons can present a considerable challenge, which considerably affects the motor function of limbs and leads to serious physical and mental pain, along with an economic burden on patients. Herein, we designed and fabricated a dipeptide hydrogel (DPH) using polypeptides P11-4 and P11-8. This hydrogel exhibited self-assembly characteristics and could be administered in vitro. To endow the hydrogel with differentiation and regeneration abilities, we added different concentrations of growth differentiation factor 5 (GDF5) to form GDF5@DPH. GDF5@DPH promoted the aggregation and differentiation of tendon stem/progenitor cells and promoted the regeneration and repair of tendon cells and collagen fibers in injured areas. In addition, GDF5@DPH inhibited inflammatory reactions in the injured area. Owing to its injectable properties, DPH can jointly inhibit adhesion and scar hyperplasia between tissues caused by endogenous inflammation and exogenous surgery and can provide a favorable internal environment for the regeneration and repair of the injured area. Overall, the GDF5@DPH system exhibits considerable promise as a novel approach to treating tendon injury.

A New Technique of Achilles Tendon Rupture Repaired by Double Transverse Mini-incision to Avoid Sural Nerve Injury: A Consecutive Retrospective Study

OBJECTIVE

Percutaneous suture is a classic technique used in Achilles tendon repair. However, the complication rates surrounding the sural nerve remain relatively high. Modified percutaneous repair technology can effectively avoid these complications; however, the surgical procedure is complicated. Hence, the present study was conducted to describe a redesigned repair technique for the Achilles tendon able to avoid sural nerve injury and reduce the complexity of the procedure.

METHODS

Data of patients with acute primary Achilles tendon rupture at our hospital from January 2019 to May 2020 were included. Subjects with expectations for surgical scarring underwent a minimally invasive-combined percutaneous puncture technique. The surgical time, requirement for conversion to other technologies, and length of postoperative hospitalization were investigated to assess efficacy. The American Orthopedic Foot & Ankle Society (AOFAS) score and the Arner-Lindholm scale (A-L scale) were used to assess postoperative clinical outcomes (> 24 months). During the 2-year follow-up, MRI was performed to observe the healing of the Achilles tendon. In addition, subjective satisfaction with surgical scar healing was recorded.

RESULTS

Twenty consecutive subjects with an average follow-up of 28.3 ± 4.5 months (range, 24-41) met the inclusion criteria. None of the 20 enrolled patients required a converted surgical approach. The mean surgical time was 26.9 ± 6.47 min (range, 20-44). None of the patients experienced dysesthesia or anesthesia around the sural nerve. No signs of postoperative infections were observed. MRI data showed that the wounds of the Achilles tendon healed completely in all the subjects. The AOFAS score increased from 55.6 ± 11.07 (range, 28-71) preoperatively to 97.8 ± 3.34 (range, 87-100) at the last follow-up. The A-L scale showed that 90% of the subjects (n = 18) presented as excellent and 10% of the subjects (n = 2) presented as good, with an excellent/good rate of 100%. Moreover, subjects' satisfaction for surgical scars was 9.1 ± 0.78 (upper limit, 10).

CONCLUSIONS

The results indicate that this technique can achieve good postoperative function, a small surgical incision, and high scar satisfaction. In addition, this technique should be widely used in suturing Achilles tendon ruptures.