Ahmet Burak SATILMIŞ, Ahmet ÜLKER, Ercan BAYAR, Şafak AYDIN ŞİMŞEK, Tolgahan CENGİZ, Tansel MUTLU
Journal of Experimental and Clinical Medicine - 2026;43(2):127-131
Acute Achilles tendon rupture is common, particularly in middle-aged individuals engaged in high-intensity sports. While surgical repair is generally preferred for active patients, there is no consensus on the optimal suture technique. The strength and stability of tendon repair depend significantly on the suture method. This study introduces a novel percutaneous suture technique and compares its biomechanical performance with the well-established Krackow and Bunnell techniques. Eighteen fresh sheep Achilles tendons were divided into three groups and repaired using the Bunnell (Group 1), the Krackow (Group 2), and the novel suture technique (Group 3). Biomechanical testing was performed using an Instron mechanical testing device to measure maximum load, elongation at maximum load, and stiffness. Statistical analysis was conducted using the Kruskal-Wallis and Mann-Whitney U tests, with significance at p < 0.05. The novel suture technique demonstrated the highest maximum load (153.55+/-33.87 N) and stiffness (4.03+/-1.48 N/mm), significantly outperforming both the Bunnell and Krackow techniques (p = 0.037, and p = 0.010, respectively). No significant differences in elongation at maximum load were found between the groups (p > 0.05). Failure mode analysis showed that all tendons repaired with the novel technique failed by suture breakage, whereas the Bunnell and the Krackow groups exhibited both suture breakage and tendon pullout. The novel percutaneous suture technique provides superior biomechanical strength and stability compared to traditional methods, suggesting potential benefits for earlier mobilization and improved rehabilitation. However, its ex vivo nature and small sample size limit generalizability. Future in vivo studies and clinical trials are needed to confirm its long-term efficacy and clinical applicability, potentially reshaping Achilles tendon repair strategies.
