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Button fixation technique for Achilles tendon reinsertion: a biomechanical study
David Awogni1, Guillaume Chauvette2, Marie-Line Lemieux3
1Orthopaedic Resident, Postgraduate Year 4, Department of Surgery, Centre Hospitalier Universitaire de Sherbrooke Faculty of Medicine, Sherbrooke, Quebec, Canada.
Summary
A new button technique for Achilles tendon reinsertion offers superior fixation strength compared to traditional bone anchors. This operative method shows promise for treating chronic insertional tendinopathy when nonoperative care fails.
Area of Science:
- Orthopedic Surgery
- Biomechanical Engineering
- Sports Medicine
Background:
- Chronic insertional tendinopathy of the Achilles tendon is a common and debilitating condition.
- Surgical intervention, involving tendon detachment and debridement, is considered when conservative treatments fail.
- Current surgical fixation methods include bone anchors, but their biomechanical performance can be limiting.
Purpose of the Study:
- To biomechanically evaluate a novel button fixation technique for Achilles tendon reinsertion.
- To compare the fixation strength of the button technique against two standard bone anchor methods.
- To analyze failure mechanisms associated with each fixation technique.
Main Methods:
- A biomechanical study utilizing 40 fresh-frozen cadaver specimens.
- Comparison of three Achilles tendon reinsertion fixation techniques: single row anchors, double row anchors, and buttons.
- Measurement of ultimate load to failure and identification of failure modes for each technique.
Main Results:
- The button technique demonstrated significantly higher median fixation strength (764 N) compared to double row anchors (412 N) and single row anchors (338 N).
- Button fixation strength was 202% of double row anchors and 255% of single row anchors.
- Failure mechanisms differed, with suture breakage common in buttons and implant pull-out prevalent in bone anchors.
Conclusions:
- Achilles tendon reinsertion using the button technique provides superior pull-out strength compared to tested bone anchor systems.
- The button technique represents a biomechanically stronger option for Achilles tendon repair.
- This finding has implications for optimizing surgical outcomes in patients with chronic Achilles tendinopathy.
