Stem Cell-Bearing Suture Improves Achilles Tendon Healing in a Rat Model
Samuel B. Adams, Jr, MD, Margaret A. Thorpe, BS, Brent G. Parks, MSc, Gary Aghazarian, BS, Elizabeth Allen, MD, and Lew C. Schon, MD
Repair of acute or chronically injured tendons and tendon transfers are commonplace in foot and ankle surgery. Tendon healing is a slow and complicated process that results in inferior structural and functional properties when compared to healthy tendon tissue. Repaired or tenodesed tendons are at risk for rerupture or loss of fixation if exposed to high tensile loads early in the postoperative period. However, during the postoperative immobilization period, inadequate limb movement promotes adhesions that can result in deficits in strength and function. Therefore, future advances in tendon repair should focus on improving early postoperative tendon repair quality to maximize functional outcome.
Modern postoperative rehabilitation protocols for Achilles tendon repair call for accelerated weight-bearing, range of motion, and return to sport. However, early motion before healing may promote excessive gap formation at the repair site and an elongated tendon, leading to a reduction in tensile strength and a delay in healing. Separation of tendon ends has been clearly demonstrated after Achilles repair. Also, weakness in end-range plantarflexion after Achilles tendon repair has been attributed to excess tendon lengthening. These data further support the need for improved early tendon repair quality.