In vitro biomechanical comparison of polypropylene mesh, modified three-loop pulley suture pattern, and a combination for repair of distal canine achilles' tendon injuries.

OBJECTIVE: To compare mechanical stability between a novel polypropylene mesh repair (Mesh), a modified 3-loop pulley suture (Suture), and a combination of the techniques (Suture+Mesh) for the repair of distal canine Achilles' tendon ruptures. STUDY DESIGN: In vitro mechanical evaluation. SAMPLE POPULATION: Cadaveric canine Achilles' tendon/calcaneus units (n=34). METHODS: Constructs were loaded under tension to failure in a materials testing machine with synchronized kinematic analysis. Ultimate load to failure, global construct stiffness, and force required to reach 1 and 3 mm gap formation was recorded. RESULTS: Ultimate load to failure was greatest for the Suture+Mesh group and lowest for the Suture group. The Suture+Mesh technique afforded a significantly greater global stiffness than the Suture or Mesh treatments. Force to generate 1 and 3 mm gap formation was greatest with the Suture group. CONCLUSIONS: The Suture+Mesh group had the highest ultimate load to failure and afforded the greatest global stiffness though it had no added benefit to resist local gap formation at the repair. CLINICAL RELEVANCE: Achilles' ruptures repaired with suture can be augmented with mesh to increase the ultimate load to failure, but as currently tested, there was a decrease in resistance to gap formation At this time we cannot recommend Mesh or the Suture+Mesh techniques without further testing.