Biomechanical Comparison of Transosseous Four-strand Tendon Suture Patterns for Repair of Ruptured Distal Common Calcaneal Tendon: An Ex Vivo Study in Dogs

There is no golden standard method of suturing for distal common calcaneal tendon rupture in dogs. Thus this study aimed to evaluate and compare the mechanical characteristics of three distinct transosseous suture (TOS) repair techniques, which were specifically developed to treat ruptured distal common calcaneal tendons and to identify golden standard suturing method. The study was performed using 30 hind limbs obtained from 15 canine cadavers with weights ranging between 7.9 kg and 11.4 kg. The repair methods using modified Becker suture (group 1), modified Krackow suture (group 2), and modified double-Tsuge suture (group 3) were randomly assigned. Each group contained 10 samples. Each repair technique was used, and all the samples were fixed on a wooden board at an angle of 135 º. Mechanical tests were performed by applying tension, and the loads at gap formations of 1, 2, and 3 mm, as well as the load at the time of failure, were measured. Group 1 had significantly higher strength than groups 2 and 3 in all three displacement criteria (1, 2, and 3 mm) with a p-value less than 0.05. The mean maximum failure load was significantly high in group 1 (133.0 ± 8.5 N) followed by group 2 (128.1 ± 11.8 N), and then, group 3 (88.3 ± 10.9). Therefore, in terms of clinical outcomes and dynamic biomechanical properties related to tendon healing, the modified Becker suture is the most effective method among TOS repairs for treating distal common calcaneal tendon rupture in dogs.