Achilles tendon repair: Achillon system vs. Krackow suture: An anatomic in vitro biomechanical study

Background Limited open repairs of acutely ruptured Achilles tendon, using the Achillon device, are becoming a frequently used method of treatment. To date there are no biomechanical studies comparing the strength of the Achillon repair to the Krackow repair. This study provides a direct comparison of the strength of these two repair techniques. Methods Using 10 paired cadaveric Achilles tendon specimens; repairs were performed using a Krackow technique on one specimen and a repair with the Achillon Suture System on the contralateral specimen. All repairs were made with identical suture material. Specimens were tested for ultimate strength using a servo-hydraulic testing device. Findings The mean load to failure of the control group (Krackow suture) was 276 N (standard deviation 87.0), and for the experimental group (Achillon suture) was 342 N (standard deviation 92.8). Using a Wilcoxon test this result was found to be statically significant (P = 0.03). Interpretation The current study has demonstrated that the Achillon repair is stronger in a cadaveric biomechanical study than the Krackow repair using identical sutures. This provides biomechanical evidence to support the continued use of the limited open repair as opposed to the traditional open repair.