Bioprotection of Tendon Repair: Adjunctive Use of Botulinum Toxin A in Achilles Tendon Repair in the Rat

Jianjun Ma; Jian Shen; Smith, Beth Paterson; Ritting, Andrew; Smith, Thomas L.; Koman, L. Andrew
October 2007
Journal of Bone & Joint Surgery, American Volume;Oct2007, Vol. 89-A Issue 10, p2241
Academic Journal
Background: Tendon-repair techniques have evolved to increase the construct strength of the repair site in order to permit early active range of motion without tendon gap or rupture. The present study evaluated the hypothesis that the injection of botulinum neurotoxin type-A (BoNT-A) into the gastrocnemius muscle will reduce the active force production of that muscle below the force required to rupture the associated, repaired Achilles tendon. Methods: Seventy-nine rat Achilles tendons were surgically bisected and were repaired with use of a two-strand core suture with a running epitenon repair. After the repair, the animals were treated with unilateral intramuscular (gastrocnemius) injections of either BoNT-A (6 U/kg body weight) (thirty-seven rats) or saline solution (forty-two rats). Operatively treated ankles were fixed in the neutral position with a percutaneous pin for the first two days after surgery. Unrestricted ankle motion and weight-bearing were allowed after the second postoperative day. An assessment of gap formation or rupture at the repair site, electrophysiologic measurements of force applied to the tendon, and an assessment of the strength of the repaired tendon were performed. Results: Intramuscular BoNT-A injections produced a significant, reversible reduction in active muscle force (p < 0.007). Twitch and tetanus contractions decreased to approximately 25% of the values for the control side within one week, remained at <50% of the values for the control side at one month, and returned to normal levels by six months. The tetanic force capability of the muscles that had been injected with BoNT-A was fivefold to tenfold less than the force required to rupture the associated Achilles tendon for as long as four weeks after tendon repair. The spontaneous Achilles tendon rupture rate of repaired tendons in the BoNT-A group was three times lower than that in the saline solution group at one week, and the tendon rupture force was significantly higher in the BoNT-A group between one and three weeks after repair (p < 0.007). There was no significant difference in tendon rupture force between the two groups after three weeks. Conclusions: Intramuscular gastrocnemius BoNT-A injections were associated with a significant reduction in force- generating potential, such that the muscle was incapable of actively producing enough force to rupture the repaired Achilles tendon in this rat model of tendon repair. Clinical Relevance: The temporary decrease of active muscle-tendon forces produced by intramuscular BoNT-A injections has the potential to allow early active motion, to provide a pharmacologically mediated aid (bioprotection) to improve patient compliance with rehabilitation, and to enhance patient outcomes.


Related Articles

  • Biomechanical comparison of the primary stability of suturing Achilles tendon rupture: a cadaver study of Bunnell and Kessler techniques under cyclic loading conditions. Herbort, Mirco; Haber, Axel; Zantop, Thore; Gosheger, Georg; Rosslenbroich, Steffen; Raschke, Michael J.; Petersen, Wolf // Archives of Orthopaedic & Trauma Surgery;Nov2008, Vol. 128 Issue 11, p1273 

    Biomechanical studies investigating suture techniques for Achilles tendon repair used single load to failure tests in order to evaluate the maximal load capacity of the repaired construct. During early rehabilitation the repair is repetitively loaded such as exercise or daily living activities...

  • Achilles tendon allograft for augmentation of the Hanssen patellar bone grafting. Boettner, Friedrich; Monsef, Jad // Knee Surgery, Sports Traumatology, Arthroscopy;Apr2015, Vol. 23 Issue 4, p1035 

    Purpose: Severe patellar bone loss precludes the insertion of another patellar implant in revision total knee arthroplasty (TKA) and weakens the attachment of the patella to the quadriceps tendon. Hanssen described securing a tissue flap to the patellar rim allows the delivery of cancellous bone...

  • Proprioception level after endoscopically guided percutaneous Achilles tendon repair. Kaya, D.; Doral, M. N.; Nyland, J.; Toprak, U.; Turhan, E.; Donmez, G.; Citaker, S.; Atay, O. A.; Callaghan, M. J. // Muscles, Ligaments & Tendons Journal (MLTJ);2012 Supplement, p3 

    Purpose: to evaluate ankle function following endoscopically guided percutaneous Achilles tendon repair. The hypoth- esis of this study was that patients with percutaneous repair of the Achilles tendon would still display impaired involved side ankle proprioception. Methods: nineteen male...

  • Video-based Gait Analysis for Functional Evaluation of Healing Achilles Tendon in Rats. Liang, Jen-I; Chen, Meng-Yi; Hsieh, Tsung-Hsun; Liu, Chih-Yu; Lam, Chen-Fuh; Chen, Jia-Jin; Yeh, Ming-Long // Annals of Biomedical Engineering;Dec2012, Vol. 40 Issue 12, p2532 

    Video-based walking track systems have been developed for gait analysis in rat models. However, there is no previous study using video-based tracking systems to address the gait parameters to evaluate the recovery of Achilles tendon rupture models. This study conducted a comprehensive gait...

  • EARLY RESULTS OF A NEW METHOD OF TREATMENT FOR IDIOPATHIC CONGENITAL VERTICAL TALUS. Dobbs, Matthew B.; Purcell, Derek B.; Nunley, Ryan; Morcuende, Jose A. // Journal of Bone & Joint Surgery, American Volume;Jun2006, Vol. 88-A Issue 6, p1192 

    Background: The treatment of idiopathic congenital vertical talus has traditionally consisted of manipulation and application of casts followed by extensive soft-tissue releases. However, this treatment is often followed by severe stiffness of the foot and other complications. The purpose of...

  • Biomechanical comparison of three methods for distal Achilles tendon reconstruction. Wu, Ziying; Hua, Yinghui; Li, Hongyun; Chen, Shiyi; Li, Yunxia // Knee Surgery, Sports Traumatology, Arthroscopy;Dec2015, Vol. 23 Issue 12, p3756 

    Purpose: To compare the load at failure and stiffness associated with three surgical techniques for distal Achilles tendon reconstruction (AT).Methods: Nine matched pairs of fresh-frozen human cadaveric ATs were divided into three groups. Distal AT reconstruction was...

  • Compensatory hyperhidrosis: a consequence of truncal sympathectomy treated by video assisted application of botulinum toxin and reoperation. Efthymiou, Christopher Andrew; Thorpe, James Andrew Charles // European Journal of Cardio-Thoracic Surgery;Jun2008, Vol. 33 Issue 6, p1157 

    Abstract: Hyperhidrosis is a debilitating condition characterised by sweating that exceeds the need of normal thermoregulation. Surgical management of primary hyperhidrosis by upper dorsal sympathectomy is the treatment of choice for intractable hyperhidrosis, however, paradoxically it may be...

  • An Algorithm for Automated Analysis of Ultrasound Images to Measure Tendon Excursion in Vivo. Lee, Sabrina S. M.; Lewis, Gregory S.; Piazza, Stephen J. // Journal of Applied Biomechanics;Feb2008, Vol. 24 Issue 1, p75 

    The accuracy of an algorithm for the automated tracking of tendon excursion from ultrasound images was tested in three experiments. Because the automated method could not be tested against direct measurements of tendon excursion in vivo, an indirect validation procedure was employed. In one...

  • KINETIC ANALYSIS OF THE HUMAN KNEE JOINT. Wiczkowski, E.; Skiba, K. // Biology of Sport;2008, Vol. 25 Issue 1, p77 

    The article presents a kinetic analysis of the knee and stifle joint to determine its role, if any, in the spontaneous subcutaneous rupture of the Achilles tendon. The analysis was employed to define the trajectory of the point of initial insertion of the medial head of gastroenemius, which was...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics