Microstructural modeling of Achilles Tendon biomechanics focusing on bone insertion site

The interface between the Achilles Tendon (AT) and calcaneus comprises soft and hard connective tissues. Such interfaces are vulnerable to mechanical damage. Tendon to Bone Insertion Region (TBIR) has unique microstructural characteristics for reinforcement. This region constitutes almost 10% of the AT's distal end. The rest of the tendon (tendon proper) has longitudinal fiber orientation with no mineral content. Although, the TBIR lacks longitudinally organized fibers and at the same time, incorporates mineral molecules. In this study, a 3D computational model of the TBIR proposed to underline several reinforcement mechanisms. The obtained results showed that off-axis alignment of fibers, when coupled with the mineral deposition, shifts the stress concentration region to the tendon proper. In the case of altering each parameter individually, probable failure observed in the bone interface, which causes complications in surgical procedure or during healing. A gradual increase of mineral compensates for the stiffness mismatch between the AT and calcaneus. The proposed computational framework illustrated the complementary roles of fiber orientation and mineral molecules: nearly transverse orientation of fibers alleviated the stress concentration locally, while mineral deposition directly enhanced the TBIR stiffness.