Biomechanical comparison of Bunnell, modified Kessler, and Tsuge tendon repair techniques using two suture types

OBJECTIVE: The aim of this study was to compare the biomechanical properties of modified Kessler, Bunnell and Tsuge techniques in sheep Achilles tendon tear repaired using polyester and polydioxanone sutures which are also compared. METHODS: Sixty sheep Achilles tendons were cut transversely as a substitute for rupture and repaired using modified Kessler, Bunnell and Tsuge techniques with No. 2 braided polyester and monofilament polydioxanone sutures. Specimens were loaded to failure. Four biomechanical parameters - ultimate strength (US), strength to 2 mm gap (S2G), strength to 5 mm gap (S5G) and Young's modulus (YM) - were recorded for statistical analysis. RESULTS: The Tsuge-Polyester group demonstrated the highest results regarding S2G (21.24±4.75 N) (p=.002) and S5G (38.91±7.45 N) (p=.002). According to YM, the Bunnell-Polyester group was the most superior (1929.9±512.28 kilopascal) (p=.009). In the repairs with the polydioxanone suture, Bunnell technique achieved the best purchase with regard to S2G (18.14±6.86 N) (p=.006) and S5G (35.69±13.49 N) (p=.015). The difference between the three repair techniques with the polydioxanone suture was statistically insignificant regarding US (p=.252) and YM (p=.338). Concerning the repairs with the polyester suture, the repair techniques demonstrated no statistically significant difference in terms of US (p=.195), S2G (p=.667), S5G (p=.689) and YM (p=.195). Regarding the mean S2G and S5G values, the polyester suture was significantly superior to the polydioxanone suture in modified Kessler repairs (S2G: p<.001, S5G: p=.001) and Tsuge repairs (S2G: p<.001, S5G: p=.009). The polyester suture was also significantly superior to the polydioxanone suture in the modified Kessler repairs with respect to YM (p=.003). CONCLUSION: This study supports the opinion that Tsuge technique is a promising procedure in Achilles tendon repair (ATR). For Tsuge and modified Kessler repairs, braided polyester suture use appears more advantageous compared to monofilament polydioxanone suture use in biomechanical terms.