Doctoral Dissertations

Orcid ID

http://orcid.org/0000-0002-6568-6774

Date of Award

12-2024

Degree Type

Dissertation

Degree Name

Doctor of Philosophy

Major

Biomedical Engineering

Major Professor

Dustin L. Crouch

Committee Members

David E. Anderson, Andrew K. Dickerson, Jeffrey A. Reinbolt

Abstract

The incidence of Achilles tendon rupture has increased from 11 to 37 per 100,000 population in recent decades with these ruptures causing pain, swelling and disability in the patient. Critically sized tendon gaps, which are too large to heal spontaneously, are currently treated with tendon grafts, but the use of grafts have some challenges such as donor site morbidity, risk of disease transmission, and potential mismatches in length and size. An artificial tendon can address these challenges and may be customizable for each patient. If the whole tendon is replaced with an artificial tendon, suture anchors are one option for attaching the artificial tendon to bone. The mechanical characteristics of the suture anchor used in musculoskeletal reconstructions (e.g. to attach an artificial tendon) can limit the strength of the attachment and lead to premature failure. The objectives of this dissertation were to (1) investigate the reasons for in vivo failures of suture anchors used to attach artificial Achilles tendons in a rabbit model, (2) quantify the maximum failure load of suture anchors identified as suitable for attaching artificial tendons in rabbit, and (3) evaluate the effects of artificial Achilles tendon on hindlimb biomechanics and muscle morphology in rabbits. We observed that neither suture size (1 or 5) nor time of implantation (delayed or immediate) was a causative factor for the failures. In addition, suture anchors with raised eyelets decreased suture strength compared to those with embedded eyelets, irrespective of loading condition. We also found that artificial Achilles tendon preserved average ground contact area, peak vertical force and vertical impulse. It improved muscle cross-sectional area (CSA) and could potentially mitigate loss of muscle mass and length. These outcomes can help surgeons improve their choice of anchors for soft tissue reconstructions, reduce the risk of revision surgeries which are painful and costly to patients, and address the challenges associated with the use of tendon grafts for treating tendon ruptures.

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