Efficacy of repair techniques of the Achilles tendon: A meta-analysis of human cadaveric biomechanical studies

Achilles injuries are very common, mainly among young athletes. When indicated, the surgical treatment aims for strong repairs that can resist distraction and consequently ruptures. The majority of the published clinical meta-analyses reported comparisons between broad treatment modalities such as conservative treatment, open, and minimally invasive surgery.A meta-analysis has been conducted to assess further clinical and biomechanical variables on human cadavers related to the efficacy of Achilles repair. A total of 26 studies with 596 legs met the inclusion criteria. The maximal load to failure was set as the primary outcome. Eleven studies were amenable to meta-analysis.In the reinsertion group, the analysis of the single row vs. double row subgroup showed a significantly higher strength for the latter (1.27, 95% CI=0.748-1.806, I2=81%, P<0.0001). In the mid-tendon repair group, the Achillon vs. Krackow sutures and the Bunnell vs. Krackow sutures subgroups showed no difference while the Bunnell and Krakow sutures were significantly stronger than the Kessler sutures (0.96, 95% CI=0.510-1.405, I2=63.3%, P<0.0001 and 1.37, 95% CI=2.286-0.468, I2=83.4%, P=0.003; respectively).The assessment of heterogeneity located variables such as age, suture/material type, number of strands, type of testing machine and software, preloading, ankle position and loading type as potential confounders. The results of this meta-analysis are likely to have a significant impact in clinical practice.