A comparative study of three repairing methods for acute Achilles tendon ruptures
Objective:To compare the outcomes of three methods for repairing acute Achilles tendon ruptures(ATRs).Methods:Fifty-six 5-week-old specific pathogen-free(SPF)-grade male Sprague-Dawley(SD)rats were selected and randomized into 4 groups,14 cases in each group.After adaptive feeding for one week,the rats in any three groups were subjected to surgeries for building models by sharply tran-secting the Achilles tendons of bilateral hindlimbs from the insertion site,after successful modeling,the ruptured Achilles tendons were repaired by using surface suture(surface suture group),point suture(point suture group),and transosseous suture(transosseous suture group),respectively;while,the ones in the remained group(blank group)underwent surgeries for merely exposing(through the same ap-proach)but not transecting the Achilles tendons,followed by sewing up the incision.At postoperative week 1 and 4,7 rats were randomly se-lected from each group for measuring the ankle pain score,serum interleukin(IL)-1 β level,and ultimate load to failure in Achilles tendon,moreover,the histopathological changes in Achilles tendon was observed at postoperative week 4.Results:① At postoperative week 1,the ankle plantar flexion and dorsal extension pain scores were higher in surface suture group,point suture group and transosseous suture group compared to blank group(plantar flexion:P=0.000,P=0.000,P=0.000;dorsal extension:P=0.000,P=0.000,P=0.000);the ankle plantar flexion pain score was higher in surface suture group and point suture group compared to transosseous suture group(P=0.000,P=0.019);the ankle dorsal extension pain score was higher in surface suture group compared to transosseous suture group(P=0.001);fur-ther pairwise comparison in the ankle plantar flexion and dorsal extension pain scores among the rest groups showed no statistical signifi-cance.At postoperative week 4,the ankle plantar flexion and dorsal extension pain scores were higher in surface suture group,point suture group and transosseous suture group compared to blank group(plantar flexion:P=0.000,P=0.000,P=0.000;dorsal extension:P=0.000,P=0.000,P=0.000);the ankle plantar flexion pain score was higher in surface suture group compared to transosseous suture group(P=0.044);the ankle dorsal extension pain score was higher in surface suture group and point suture group compared to transosse-ous suture group(P=0.024,P=0.000);further pairwise comparison in the ankle plantar flexion and dorsal extension pain scores among the rest groups showed no statistical significance.②At postoperative week 1 and 4,the serum level of IL-1 β was higher in surface suture group,point suture group and transosseous suture group compared to blank group(postoperative week 1:P=0.000,P=0.000,P=0.000;postoperative week 4:P=0.000,P=0.000,P=0.000);At postoperative week 1,the serum level of IL-1 β was higher in transosseous su-ture group compared to surface suture group and point suture group(P=0.003,P=0.001),while there was no statistical difference be-tween surface suture group and point suture group(P=0.542);At postoperative week 4,there was no statistical difference in serum level of IL-1 β among surface suture group,point suture group and transosseous suture group(P=0.864,P=0.622,P=0.748).③At postoperative week 1 and 4,the ultimate load to failure in Achilles tendon was smaller in surface suture group,point suture group and transosseous suture group compared to blank group(postoperative week 1:P=0.000,P=0.000,P=0.000;postoperative week 4:P=0.000,P=0.000,P=0.000).At postoperative week 1,the ultimate load to failure in Achilles tendon was greater in transosseous suture group compared to surface suture group(P=0.023);there was no statistical difference in ultimate load to failure in Achilles tendon between point suture group and surface suture group and between point suture group and transosseous suture group(P=0.779,P=0.053).At postoperative week 4,the ul-timate load to failure in Achilles tendon was greater in transosseous suture group compared to surface suture group(P=0.011);there was no statistical difference in ultimate load to failure in Achilles tendon between point suture group and surface suture group and between point suture group and transosseous suture group(P=0.154,P=0.217).④The results of HE staining showed that,at postoperative week4,the normal structure,with tightly arranged muscle fibers(without obvious degeneration)and visible fibrous connective tissues(without infiltration by inflammatory cells),were observed in Achilles tendon tissues of rats from blank group;the moderately abnormal structure,manifesting as dense connective tissue,mild infiltration by inflammatory cells and slight neovascularization,was observed in Achilles tendon tissues of mo-del rats from surface suture group;the moderately abnormal structure,with increased muscle fibers,enlarged gaps in some areas,visible fi-brous tissue,mild infiltration by inflammatory cells,and slight neovascularization,were observed in Achilles tendon tissues of model rats from point suture group;the slightly abnormal structure,manifesting as dense connective tissue,massive infiltration by inflammatory cells,and slight neovascularization,was observed in Achilles tendon tissues of model rats from transosseous suture group.Conclusion:The transosseous suture can achieve better biomechanical stability in repairing acute ATRs compared to surface suture and point suture,while,it leads to greater trauma compared the latter two.
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