Augmented Tendon Achilles Repair Using a Tissue Reinforcement Scaffold: A Biomechanical Study

Background: Missed or chronic Achilles tendon ruptures may have muscle atrophy and tendon retraction resulting in a defect that must be augmented with endogenous or exogenous materials. The Artelon® Tissue Reinforcement (ATR) scaffold is a readily available synthetic degradable poly(urethane urea) material used to augment tendon repair. The objective of this study was to compare human cadaveric Achilles tendon repairs with and without ATR. Materials and Methods: Eighteen fresh frozen human cadaver limbs were dissected and the tendon transected 2 cm proximal to the calcaneal insertion. The control group of nine specimens was repaired with sutures, while the experimental group was repaired with sutures and reinforced with a tubularized patch of ATR. Specimens were tested for ultimate load to failure in an Instron machine after preloading to 10 N followed by cyclic loading for 20 cycles from 2 to 30 N. Results: The ultimate load to failure in the control group was a mean of 248.1 N ± 19.6 (202 to 293 at 95% CI) versus 370.4 N ± 25.2 (312 to 428 at 95% CI) in the ATR group. The ultimate load to failure was 370.4 ± 25.2 N (312 to 428 at 95% CI) and 248.1 ± 19.6 N (202 to 293 at 95% CI) in the experimental and control groups, respectively (p = 0.0015). Creep of the ATR augmented group was 2.0 ± 0.5 mm, compared to 3.1 ± 1.1 mm for the control group (p = 0.026). Conclusion: ATR provided a statistically significant improvement in load to failure when compared to control specimens in a cadaver model. Clinical Relevance: This finding may allow for development of more aggressive rehabilitation techniques following chronic Achilles tendon repairs.