Original Article
Is the Dresden technique a mechanical design of choice suitable for the repair of middle third Achilles tendon ruptures? A biomechanical study
¿Es la técnica Dresden un diseño mecánico de elección apropiado para la reparación de roturas de tercio medio del tendón de Aquiles? Ensayo biomecánico Dresden technique
C. de la Fuentea,b,
, G. Carreño-Zillmannc,d, H. Marambioe,f, H. Henríqueze,g,f
Corresponding author
a Carrera de Kinesiología, UDA cs. de Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
b Programa de Magíster en Ciencias de la Ingeniería, mención Ingeniería Biomédica, Universidad de Valparaíso, Santiago, Chile
c Programa de Quiropraxia, Facultad de Ciencias de la Salud, Universidad Central, Santiago, Chile
d Facultad de Ciencias de la Salud, Universidad Iberoamericana de Ciencias y Tecnología, Santiago, Chile
e Servicio de Traumatología, Clínica Santa Maria, Santiago, Chile
f Escuela de Medicina, Universidad de Chile, Santiago, Chile
g Servicio de Tobillo y Pie, Instituto Traumatológico “Teodoro Gebauer Weisser”, Santiago, Chile
Read
2173
Timeswas read the article
437
Total PDF
1736
Total HTML
Share statistics
array:24 [ "pii" => "S1988885616300347" "issn" => "19888856" "doi" => "10.1016/j.recote.2016.08.001" "estado" => "S300" "fechaPublicacion" => "2016-09-01" "aid" => "622" "copyright" => "SECOT" "copyrightAnyo" => "2016" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Esp Cir Ortop Traumatol. 2016;60:279-85" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1 "HTML" => 1 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S1888441516300443" "issn" => "18884415" "doi" => "10.1016/j.recot.2016.06.004" "estado" => "S300" "fechaPublicacion" => "2016-09-01" "aid" => "622" "copyright" => "SECOT" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Esp Cir Ortop Traumatol. 2016;60:279-85" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 127 "formatos" => array:2 [ "HTML" => 86 "PDF" => 41 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original</span>" "titulo" => "¿Es la técnica Dresden un diseño mecánico de elección apropiado para la reparación de roturas de tercio medio del tendón de Aquiles? Ensayo biomecánico" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "279" "paginaFinal" => "285" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Is the Dresden technique a mechanical design of choice suitable for the repair of middle third Achilles tendon ruptures? A biomechanical study" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figura 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1319 "Ancho" => 990 "Tamanyo" => 146731 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Mecanismo de tracción.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C. de la Fuente, G. Carreño-Zillmann, H. Marambio, H. Henríquez" "autores" => array:4 [ 0 => array:2 [ "nombre" => "C." "apellidos" => "de la Fuente" ] 1 => array:2 [ "nombre" => "G." "apellidos" => "Carreño-Zillmann" ] 2 => array:2 [ "nombre" => "H." "apellidos" => "Marambio" ] 3 => array:2 [ "nombre" => "H." "apellidos" => "Henríquez" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1988885616300347" "doi" => "10.1016/j.recote.2016.08.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1988885616300347?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1888441516300443?idApp=UINPBA00004N" "url" => "/18884415/0000006000000005/v1_201608210056/S1888441516300443/v1_201608210056/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1988885616300359" "issn" => "19888856" "doi" => "10.1016/j.recote.2016.08.002" "estado" => "S300" "fechaPublicacion" => "2016-09-01" "aid" => "621" "copyright" => "SECOT" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Esp Cir Ortop Traumatol. 2016;60:286-95" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1 "HTML" => 1 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Use of grafts in rotator cuff re-rupture" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "286" "paginaFinal" => "295" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Utilización de injertos en la reparación de rerroturas del manguito rotador" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0030" "etiqueta" => "Figure 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 1053 "Ancho" => 1450 "Tamanyo" => 77213 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Distribution of results according to the Constant test.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Jiménez-Martín, F.J. Santos-Yubero, F.J. Najarro-Cid, S. Navarro-Martínez, M. Zurera-Carmona, S. Pérez-Hidalgo" "autores" => array:6 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Jiménez-Martín" ] 1 => array:2 [ "nombre" => "F.J." "apellidos" => "Santos-Yubero" ] 2 => array:2 [ "nombre" => "F.J." "apellidos" => "Najarro-Cid" ] 3 => array:2 [ "nombre" => "S." "apellidos" => "Navarro-Martínez" ] 4 => array:2 [ "nombre" => "M." "apellidos" => "Zurera-Carmona" ] 5 => array:2 [ "nombre" => "S." "apellidos" => "Pérez-Hidalgo" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1888441516300431" "doi" => "10.1016/j.recot.2016.06.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1888441516300431?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1988885616300359?idApp=UINPBA00004N" "url" => "/19888856/0000006000000005/v1_201608210033/S1988885616300359/v1_201608210033/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1988885616300360" "issn" => "19888856" "doi" => "10.1016/j.recote.2016.06.003" "estado" => "S300" "fechaPublicacion" => "2016-09-01" "aid" => "623" "copyright" => "SECOT" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Esp Cir Ortop Traumatol. 2016;60:271-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2 "formatos" => array:2 [ "HTML" => 1 "PDF" => 1 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Peri-prosthetic femoral fractures of hip or knee arthroplasty. Analysis of 34 cases and a review of Spanish series in the last 20 years" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "271" "paginaFinal" => "278" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Fracturas periprotésicas de fémur sobre prótesis de cadera y rodilla. Análisis de una serie de 34 casos y revisión de las series españolas en los últimos 20 años" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Gracia-Ochoa, I. Miranda, S. Orenga, V. Hurtado-Oliver, F. Sendra, A. Roselló-Añón" "autores" => array:6 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Gracia-Ochoa" ] 1 => array:2 [ "nombre" => "I." "apellidos" => "Miranda" ] 2 => array:2 [ "nombre" => "S." "apellidos" => "Orenga" ] 3 => array:2 [ "nombre" => "V." "apellidos" => "Hurtado-Oliver" ] 4 => array:2 [ "nombre" => "F." "apellidos" => "Sendra" ] 5 => array:2 [ "nombre" => "A." "apellidos" => "Roselló-Añón" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1888441516300455" "doi" => "10.1016/j.recot.2016.06.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1888441516300455?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1988885616300360?idApp=UINPBA00004N" "url" => "/19888856/0000006000000005/v1_201608210033/S1988885616300360/v1_201608210033/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Is the Dresden technique a mechanical design of choice suitable for the repair of middle third Achilles tendon ruptures? A biomechanical study" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "279" "paginaFinal" => "285" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "C. de la Fuente, G. Carreño-Zillmann, H. Marambio, H. Henríquez" "autores" => array:4 [ 0 => array:4 [ "nombre" => "C." "apellidos" => "de la Fuente" "email" => array:1 [ 0 => "delafuentte@gmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "G." "apellidos" => "Carreño-Zillmann" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 2 => array:3 [ "nombre" => "H." "apellidos" => "Marambio" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">f</span>" "identificador" => "aff0030" ] ] ] 3 => array:3 [ "nombre" => "H." "apellidos" => "Henríquez" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">g</span>" "identificador" => "aff0035" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">f</span>" "identificador" => "aff0030" ] ] ] ] "afiliaciones" => array:7 [ 0 => array:3 [ "entidad" => "Carrera de Kinesiología, UDA cs. de Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Programa de Magíster en Ciencias de la Ingeniería, mención Ingeniería Biomédica, Universidad de Valparaíso, Santiago, Chile" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Programa de Quiropraxia, Facultad de Ciencias de la Salud, Universidad Central, Santiago, Chile" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Facultad de Ciencias de la Salud, Universidad Iberoamericana de Ciencias y Tecnología, Santiago, Chile" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Servicio de Traumatología, Clínica Santa Maria, Santiago, Chile" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Escuela de Medicina, Universidad de Chile, Santiago, Chile" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Servicio de Tobillo y Pie, Instituto Traumatológico “Teodoro Gebauer Weisser”, Santiago, Chile" "etiqueta" => "g" "identificador" => "aff0035" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Es la técnica Dresden un diseño mecánico de elección apropiado para la reparación de roturas de tercio medio del tendón de Aquiles? Ensayo biomecánico Dresden technique" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 410 "Ancho" => 2531 "Tamanyo" => 58754 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Mechanical failure of the repairs. (A) Tendon tearing with the Dresden technique. (B) Rupture of the suture with the Kessler technique.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Rupture of the middle third of the Achilles tendon has an incidence of 18 cases per 100,000 inhabitants-year, and it mainly affects amateur sportsmen aged from 30 to 50 years old.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">It was traditionally repaired using open surgery and techniques such as those of Krackow, Kessler or Bunnell.<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">2–8</span></a> Nevertheless, there is controversy as to whether the comorbidity associated with tissue damage following open surgical repair is greater than is the case with a percutaneous repair.<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">9–12</span></a> There is also controversy as to whether the mechanical design of repair of the middle third of the tendon using a percutaneous procedure gives a suitable level of stability and rate of mechanical failure under traction.</p><p id="par0015" class="elsevierStylePara elsevierViewall">A mechanically stable tendon repair technique is essential to guarantee suitable tendon connection after surgery. This is not always achieved naturally following rupture of the Achilles tendon, given the elastic retraction of the tendon ends. Additionally, suitable connection of the tendon makes it possible to re-establish its length at close to physiological values, while failure to ensure this may lead to future alterations in the relationship between the strength and length of the plantiflexor mechanism.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">13</span></a> On the other hand, a technique which leads to inappropriate failure such as failure of the tendon does not guarantee that the supporting points of the suture on the tendon (the tendon-suture interface) will not lead to structural damage under traction and secondarily lead to a change in the length of the tendon. Mechanical designs differ in this respect, as they favour suture deformation so that it generates more tensile dissipation.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The Dresden percutaneous repair technique as described by Amlang et al.<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">9,10</span></a> has been described as giving positive clinical results.<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">9,10,14</span></a> Other authors have also found similar clinical advantages in the use of this technique.<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">15,16</span></a> Its main characteristics in comparison with open surgical techniques are a reduced sural nerve lesion and a low level of re-rupture due to the preservation of the paratendon, tissue which plays an important role in the tendon repair process.<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">9,10,14</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Nevertheless, it is not known whether the Dresden technique is a suitable mechanical alternative of choice for the repair of ruptures of the middle third of the Achilles tendon, as opposed to the techniques which are usually used. These include the double modified Kessler repair,<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">17</span></a> which has proven to be a frequently chosen technique thanks to its suitable levels of tensile strength,<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">3,5</span></a> its reproducibility, the fact that it has fewer negative effects on tendon microcirculation and that it is less invasive than other open techniques.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">3</span></a> Our aim is therefore to compare the mechanical failure rate of the Dresden technique for Achilles tendon repair to the double modified Kessler control technique. Secondarily, our objective is to compare the maximum strength of the Dresden repair technique to that of the double modified Kessler control technique. Our hypotheses are: (1) That the Dresden and double modified Kessler techniques give rise to equal mechanical failure rates due to traction, and (2) that the Dresden and double modified Kessler repairs have the same tensile strength against traction.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and method</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study design</span><p id="par0030" class="elsevierStylePara elsevierViewall">An experimental – comparative study was conducted from June 2014 to June 2015 in the biomechanical unit of the “Instituto Traumatológico Teodoro Gebauer Weisser” (Santiago, Chile). This study was approved by the Ethics Committee of the “Instituto Traumatológico Teodoro Gebauer Weisser” (Santiago, Chile).</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Specimens</span><p id="par0035" class="elsevierStylePara elsevierViewall">A total of 30 ruptured Achilles tendons in bovine specimens (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>) were obtained from animals under the age of 2 years old and frozen at −18<span class="elsevierStyleHsp" style=""></span>°<span class="elsevierStyleSmallCaps">C</span> during the first 24<span class="elsevierStyleHsp" style=""></span>h after sacrifice. Each piece was unfrozen at random by remaining in a defrosting room at ambient temperature during 12<span class="elsevierStyleHsp" style=""></span>h before the biomechanical test was performed.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Procedure</span><p id="par0040" class="elsevierStylePara elsevierViewall">Each specimen was dissected until the whole Achilles tendon was exposed (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The Achilles tendon was then completely ruptured at 4.5<span class="elsevierStyleHsp" style=""></span>cm from the calcaneus bony prominence by making a cut with a number 21 scalpel perpendicular to the fibres, with the aim of simulating a rupture in its middle third. A Dresden tenorrhaphy was then performed at random under the repair principles described by Amlang et al.<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">9,10</span></a> or the double modified Kessler procedure according to Sebastin et al.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">17</span></a> (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), using Ethibond Excel<span class="elsevierStyleSup">®</span> no. 1 braided synthetic non-absorbable suture (Ethicon endo-surgery Inc., Somerville, U.S.A.).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The Dresden technique was performed in open mode, with symmetrical points of support and balanced on the body of the Achilles tendon (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). The experimental design included a first suture using a straight needle that passed through the central part of the Achilles tendon from the medial to the lateral plane at a distance of 1<span class="elsevierStyleHsp" style=""></span>cm distally from the rupture. The same suture immediately passed through from the lateral to the medial plane at 0.8<span class="elsevierStyleHsp" style=""></span>cm from the rupture and the free thread passed through from the lateral to the medial plane of the central part of the Achilles tendon and the free thread passed through from the lateral to the medial plane in the central part of the Achilles tendon at 1.0<span class="elsevierStyleHsp" style=""></span>cm from the rupture. Subsequently a second suture using a second straight needle passed through from the medial plane to the lateral plane in the central part of the Achilles tendon, parallel to the first suture at a distance of 1.5<span class="elsevierStyleHsp" style=""></span>cm distally to the rupture. This second suture immediately passed through from the lateral to the medial plane at 1.3<span class="elsevierStyleHsp" style=""></span>cm from the rupture and the free thread passed through from the lateral plane to the medial plane in the central part of the Achilles tendon, at 1.5<span class="elsevierStyleHsp" style=""></span>cm from the rupture. Once the sutures had passed through the tendon, the first suture was tensed until the tendon ends had connected termino-terminal, creating a first double knot followed by 5 simple knots. The second suture was immediately tensed and checked to ensure that the ends of the tendon connected in termino-terminal mode, ending with a first double knot followed by 5 simple knots, as shown in <a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Biomechanical test</span><p id="par0050" class="elsevierStylePara elsevierViewall">Each specimen was mounted in a traction mechanism (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>) where it was subjected to a maximum traction test at 6<span class="elsevierStyleHsp" style=""></span>mm/s.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">18</span></a> The mechanism was composed of the 7000<span class="elsevierStyleHsp" style=""></span>N device (Linear ActuatorWorld, China) controlled by Matlab7.1 software (Mathworks Inc., U.S.A.). A toothed compressive clamp was placed at the distal end of the device (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>) to hold the proximal part of the tendon end.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">3</span></a> The bone (distal) end of the specimen was attached to a power sensor (RevereTransducer Inc., U.S.A.) using a 5<span class="elsevierStyleHsp" style=""></span>mm surgical steel nail to obtain the strength data. The latter were acquired at a rate of 1000 data per second and stored in a in a matrix of strength and time<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>samples.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Measurements</span><p id="par0055" class="elsevierStylePara elsevierViewall">Before performing the biomechanical test the anteroposterior and mediolateral diameter in the rupture zone was recorded (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>) using a slide gauge with a precision of 0.01<span class="elsevierStyleHsp" style=""></span>mm.</p><p id="par0060" class="elsevierStylePara elsevierViewall">For the maximum traction test the load-time curve was recorded for each specimen (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>), obtaining the maximum resistance variable (peak force). The mechanical failure variable was categorised as knot if there was knot failure, suture if the suture tore or tendon if the tendon ruptured in the first drop in maximum resistance in the load – time curve (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Data analysis</span><p id="par0065" class="elsevierStylePara elsevierViewall">The data were described using the arithmetic mean and standard deviation. Data normality was then checked using the Shapiro–Wilk test. To compare the proportions of mechanical failure a 3<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>2 contingency table was created and Fisher's exact test was used with 2 tails and type I error of 5%. To compare the arithmetic means of the maximum strengths a 2 tail Student's <span class="elsevierStyleItalic">t</span>-test was used with a type I error of 5%. All statistical calculations were developed using STATA 12 software (StataCorp LP, Texas, U.S.A.).</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Results</span><p id="par0070" class="elsevierStylePara elsevierViewall">The data presented a normal distribution (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>.05). The tendon characteristics prior to the biomechanical test are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. The proportions of mechanical failure of the repairs area shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>, and the most frequent was tearing of the tendon for the Dresden technique and rupture of the suture for the Kessler technique. Finally, the results obtained in the maximum traction tests are shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>, in which the Dresden repair attained a strength 58.7% greater than the Kessler repair.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">In spite of the enormous range of Achilles tendon repair techniques<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">19</span></a> and the secondary comorbidities following open repairs, there is still a lack of knowledge about whether the new techniques with positive clinical results developed over recent years, such as the Dresden repair<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">9,10,14–16</span></a> have a suitable mechanical design to withstand tensile loads in comparison with other repairs that had proven successful in the past from a mechanical point of view. Our study therefore compared the proportion of mechanical failures with the Dresden technique in comparison with the double modified Kessler control repair technique. Additionally and secondarily the maximum strength of the Dresden repair technique was compared to that of the double modified Kessler control repair.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Our main finding was the difference in proportions of mechanical failure between the repairs, as tendon tear was the most frequent failure mechanism in the Dresden repair, while rupture of the suture was the most frequent mechanism for the Kessler repair. Secondarily, our study found that the Dresden technique gives a higher tensile strength than the Kessler technique. These results suggest that stress is dissipated better over the suture threads in the Dresden repair combined with the suture-tendon interface (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). This makes it possible to create greater tensile strength than is the case in the Kessler repair, which, given the results, seems to have reached the maximum permissible deformation of one of its sutures, leading to its tearing early in comparison with the Dresden repair, as is shown by the double sawtooth pattern in <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>. Nevertheless, the greater strength of the Dresden technique is accompanied by structural damage to the tendon (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>) to the degree in which it reaches the region of non-proportional plastic behaviour, as is denoted by the smoothed pattern of <a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>, where it may lead to increased tendon length<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">13</span></a> before causing a repeat rupture, unlike the Kessler repair. This phenomenon suggests that use of the Dresden technique in combination with tensile loads applied unsuitably, as may occur during early rehabilitation,<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">13,20</span></a> could cause silent changes in tendon length during rehabilitation and leading to reduced plantiflexor efficiency of the gastrosoleus mechanism<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">13</span></a> in spite of the higher strength of the mechanical design of the Dresden repair. On the other hand, use of the double modified Kessler technique suggests that, in combination with unsuitable tensile loads, re-rupture may occur at loads 58.7% lower than is the case for the Dresden repair, leading to plastic deformation predominantly of the sutures, unlike the Dresden technique. This suggests that there is more damage to the tendon in the Dresden technique, in the form of repeat rupture caused by tensile loads (<a class="elsevierStyleCrossRef" href="#fig0025">Fig. 5</a>).</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Studies undertaken in finger flexor tendons suggest that one of the most important factors for tensile strength is the number of sutures which pass between the 2 ends of the tendon, together with surgical technique.<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">21–23</span></a> Due to this, an increase in the threads used for the Dresden repair may give rise to better stress distribution. This could be a way of preventing tendon lengthening phenomena during early rehabilitation, together with damage caused by stress concentration at the tendon-suture interface and repeat rupture; nevertheless, this would have to be checked by future studies. On the other hand, an asymmetrical load on the sutures leads to worse control of the tensile balance, as the results with the Kessler repair suggest. However, this study has only compared both repairs in open mode, and it is not known whether a percutaneous Dresden repair has a negative effect on the type of failure and mechanical resistance, so that new research would be needed to explore the said effect.</p><p id="par0090" class="elsevierStylePara elsevierViewall">The literature reports maximum values for the Dresden repair using 628<span class="elsevierStyleHsp" style=""></span>N Fiberwire 2.0 suture (Arthrex, Naples, U.S.A.),<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">24</span></a> and for the Kessler repair when 137<span class="elsevierStyleHsp" style=""></span>N PDS-1 is used (Ethicon endo-surgery Inc., Somerville, U.S.A.).<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">5</span></a> This contrasts with our results, and it is interesting that the type of suture material used affects obtaining the maximum strength, as is shown in the literature when it describes the results of using the same technique with different suture materials.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">5</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Finally, in spite of the continuing lack of agreement on the optimum procedure following the acute rupture of the middle third of the Achilles tendon,<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">14,20,25,26</span></a> our research suggests that repair using the Dresden technique in open mode is a more suitable mechanical design than the double modified Kessler technique for traction.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Level of evidence</span><p id="par0100" class="elsevierStylePara elsevierViewall">Level of evidence III.</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Ethical responsibilities</span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Protection of human and animal subjects</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors declare that the procedures followed are according to the ethical regulations of the responsible human experimentation ethics committee, and that they are also according to the World Medical Association and the Helsinki Declaration.</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Confidentiality of data</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their centre of work governing the publication of patient data.</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Right to privacy and informed consent</span><p id="par0115" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this paper.</p></span></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Conflicts of interest</span><p id="par0120" class="elsevierStylePara elsevierViewall">The authors have no conflict of interests to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:3 [ "identificador" => "xres719796" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Discussion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec724977" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres719797" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Discusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec724978" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and method" "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Study design" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Specimens" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Procedure" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Biomechanical test" ] 4 => array:2 [ "identificador" => "sec0035" "titulo" => "Measurements" ] 5 => array:2 [ "identificador" => "sec0040" "titulo" => "Data analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0045" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0050" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0055" "titulo" => "Level of evidence" ] 9 => array:3 [ "identificador" => "sec0060" "titulo" => "Ethical responsibilities" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0065" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0070" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0075" "titulo" => "Right to privacy and informed consent" ] ] ] 10 => array:2 [ "identificador" => "sec0080" "titulo" => "Conflicts of interest" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-01-26" "fechaAceptado" => "2016-06-13" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec724977" "palabras" => array:3 [ 0 => "Achilles tendon tear" 1 => "Dresden" 2 => "Mechanical design" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec724978" "palabras" => array:3 [ 0 => "Rotura del tendón de Aquiles" 1 => "Dresden" 2 => "Diseño mecánico" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To compare the mechanical failure of the Dresden technique for Achilles tendon repair with the double modified Kessler technique controlled repair technique. The maximum resistance of the two repair techniques are also compared.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A total of 30 Achilles tendon ruptures in bovine specimens were repaired with an Ethibond<span class="elsevierStyleSup">®</span> suture to 4.5<span class="elsevierStyleHsp" style=""></span>cm from the calcaneal insertion. Each rupture was randomly distributed into one of two surgical groups. After repair, each specimen was subjected to a maximum traction test. The mechanical failure (tendon, suture, or knot) rates (proportions) were compared using the exact Fisher test (<span class="elsevierStyleItalic">α</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.05), and the maximum resistances using the Student <span class="elsevierStyleItalic">t</span> test (<span class="elsevierStyleItalic">α</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.05).</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">There was a difference in the proportions of mechanical failures, with the most frequent being a tendon tear in the Dresden technique, and a rupture of the suture in the Kessler technique.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Discussion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The repair using the Dresden technique performed in the open mode, compared to the Kessler technique, has a more suitable mechanical design for the repair of middle third Achilles tendon ruptures on developing a higher tensile resistance in 58.7%. However, its most common mechanical failure was a tendon tear, which due to inappropriate loads could lead to lengthening of the Achilles tendon.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Discussion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Comparar el fallo mecánico de la técnica Dresden para la reparación del tendón de Aquiles respecto a la técnica de reparación control Kessler doble modificada. Secundariamente, comparar la resistencia máxima de la técnica de reparación Dresden respecto a la técnica de reparación control Kessler doble modificada.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Un total de 30 roturas de tendón de Aquiles en especímenes bovinos fueron reparadas con sutura Ethibond<span class="elsevierStyleSup">®</span> a 4,5<span class="elsevierStyleHsp" style=""></span>cm desde la inserción calcánea. Cada rotura fue distribuida de modo aleatorio en uno de 2 grupos quirúrgicos. Una vez reparadas, cada espécimen se sometió a una prueba de tracción máxima. Mediante una prueba exacta de Fisher (α<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,05) se compararon las tasas (proporciones) de fallo mecánico (tendón, sutura o nudo), y mediante una prueba t de Student (α<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,05), las resistencias máximas.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Las proporciones de fallo mecánico entre las reparaciones fueron diferentes, siendo el fallo mecánico más frecuente el desgarro del tendón en la técnica Dresden y la rotura de la sutura en la técnica Kessler. La reparación Dresden desarrolló 245,4<span class="elsevierStyleHsp" style=""></span>N y la reparación Kessler desarrolló 154,6<span class="elsevierStyleHsp" style=""></span>N.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Discusión</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La reparación con técnica Dresden realizada de modo abierto respecto a la técnica Kessler posee un diseño mecánico más apropiado para la reparación de roturas de tercio medio del tendón de Aquiles al desarrollar mayor resistencia tensil en un 58,7%. No obstante, su fallo mecánico más frecuente fue el desagarro tendinoso, que frente a cargas inapropiadas puede favorecer el alargamiento del tendón de Aquiles.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Discusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as: de la Fuente C, Carreño-Zillmann G, Marambio H, Henríquez H. ¿Es la técnica Dresden un diseño mecánico de elección apropiado para la reparación de roturas de tercio medio del tendón de Aquiles? Ensayo biomecánico. Rev Esp Cir Ortop Traumatol. 2016;60:279–285.</p>" ] ] "multimedia" => array:8 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1050 "Ancho" => 940 "Tamanyo" => 159033 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Repair techniques. (A) Dresden repair. (B) Kessler repair.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2527 "Ancho" => 3284 "Tamanyo" => 515075 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Diagram of the experimental surgical procedure.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1319 "Ancho" => 990 "Tamanyo" => 146731 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Traction mechanism.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 410 "Ancho" => 2531 "Tamanyo" => 58754 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Mechanical failure of the repairs. (A) Tendon tearing with the Dresden technique. (B) Rupture of the suture with the Kessler technique.</p>" ] ] 4 => array:7 [ "identificador" => "fig0025" "etiqueta" => "Figure 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 501 "Ancho" => 1900 "Tamanyo" => 172308 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Sequence of tendon tearing with the Dresden technique. (A) Specimen in repose. (B) Specimen with elastic deformation. (C) Specimen with plastic deformation. (D) Specimen with tendon failure mechanism. (E) Complete tear of the distal tendon end.</p>" ] ] 5 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Dresden \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Kessler \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Anteroposterior diameter, mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.4 (1.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.3 (1.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Mediolateral diameter, mm \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.5 (1.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.7 (1.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1183337.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Tendon characteristics.</p>" ] ] 6 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Dresden \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Kessler \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Tendon \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Suture \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Knot \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="3" align="left" valign="top"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.<span class="elsevierStyleItalic">0001</span></td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1183336.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Mechanical failure proportion of the repairs.</p>" ] ] 7 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Dresden \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col">Kessler \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Maximum strength, <span class="elsevierStyleItalic">N</span><br><span class="elsevierStyleItalic">P<.0001</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">245.4 (51.4)<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">*</span></a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">154.6 (15.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1183338.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "*" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Statistical significance (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.0001).</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Maximum strength of the repairs.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:26 [ 0 => array:3 [ "identificador" => "bib0135" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Operative versus nonoperative management of acute Achilles tendon ruptures: a quantitative systematic review of randomized controlled trials" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R. Wilkins" 1 => "L.J. Bisson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/0363546512453293" "Revista" => array:6 [ "tituloSerie" => "Am J Sports Med" "fecha" => "2012" "volumen" => "40" "paginaInicial" => "2154" "paginaFinal" => "2160" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22802271" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0140" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tendon repair with the strengthened modified Kessler, modified Kessler, and Savage suture techniques: a biomechanical comparison" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Pişkin" 1 => "A. Yücetürk" 2 => "Y. Tomak" 3 => "M. Ozer" 4 => "B. Gülman" 5 => "A. Ataman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Acta Orthop Traumatol Turc" "fecha" => "2007" "volumen" => "41" "paginaInicial" => "238" "paginaFinal" => "243" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17876126" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0145" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Biomechanical comparison of the primary stability of suturing Achilles tendon rupture: a cadaver study of Bunnell and Kessler techniques under cyclic loading conditions" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Herbort" 1 => "A. Haber" 2 => "T. Zantop" 3 => "G. Gosheger" 4 => "S. Rosslenbroich" 5 => "M.J. Raschke" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00402-008-0602-1" "Revista" => array:6 [ "tituloSerie" => "Arch Orthop Trauma Surg" "fecha" => "2008" "volumen" => "128" "paginaInicial" => "1273" "paginaFinal" => "1277" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18309504" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0150" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The strength of Achilles tendon repair: a comparison of three suture techniques in human cadaver tendons" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "B.W. McCoy" 1 => "S.L. Haddad" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Foot Ankle Int" "fecha" => "2010" "volumen" => "31" "paginaInicial" => "701" "paginaFinal" => "705" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0155" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Initial Achilles tendon repair strength – synthesized biomechanical data from 196 cadaver repairs" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "P. Sadoghi" 1 => "C. Rosso" 2 => "V. Valderrabano" 3 => "A. Leithner" 4 => "P. Vavken" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00264-012-1533-6" "Revista" => array:6 [ "tituloSerie" => "Int Orthop" "fecha" => "2012" "volumen" => "36" "paginaInicial" => "1947" "paginaFinal" => "1951" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22460821" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0160" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "High-tensile strength tape versus high-tensile strength suture: a biomechanical study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R.J. Gnandt" 1 => "J.L. Smith" 2 => "K. Nguyen-Ta" 3 => "L. McDonald" 4 => "L.E. LeClere" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arthro.2015.08.013" "Revista" => array:6 [ "tituloSerie" => "Arthroscopy" "fecha" => "2016" "volumen" => "32" "paginaInicial" => "356" "paginaFinal" => "363" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26483169" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0165" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A biomechanical comparison of an open repair and 3 minimally invasive percutaneous Achilles tendon repair techniques during a simulated, progressive rehabilitation protocol" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T.O. Clanton" 1 => "C.T. Haytmanek" 2 => "B.T. Williams" 3 => "D.M. Civitarese" 4 => "T.L. Turnbull" 5 => "M.B. Massey" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/0363546515587082" "Revista" => array:6 [ "tituloSerie" => "Am J Sports Med" "fecha" => "2015" "volumen" => "43" "paginaInicial" => "1957" "paginaFinal" => "1964" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26063402" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0170" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mechanical evaluation of different techniques for Achilles tendon repair" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Gebauer" 1 => "F.T. Beil" 2 => "J. Beckmann" 3 => "A.M. Sárváry" 4 => "P. Ueblacker" 5 => "A.H. Ruecker" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00402-007-0325-8" "Revista" => array:6 [ "tituloSerie" => "Arch Orthop Trauma Surg" "fecha" => "2007" "volumen" => "127" "paginaInicial" => "795" "paginaFinal" => "799" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17457597" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0175" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Percutaneous technique for Achilles tendon repair with the Dresden Instruments" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.H. Amlang" 1 => "P. Christiani" 2 => "P. Heinz" 3 => "H. Zwipp" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00113-005-0938-8" "Revista" => array:6 [ "tituloSerie" => "Unfallchirurg" "fecha" => "2005" "volumen" => "108" "paginaInicial" => "529" "paginaFinal" => "536" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15959748" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0180" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Die perkutane Naht der Achillessehne mit dem Dresdner Instrument" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M.H. Amlang" 1 => "P. Christiani" 2 => "P. Heinz" 3 => "H. Zwipp" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00064-006-1178-y" "Revista" => array:6 [ "tituloSerie" => "Oper Orthop Traumatol" "fecha" => "2006" "volumen" => "18" "paginaInicial" => "287" "paginaFinal" => "289" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17103128" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0185" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of acute Achilles tendon ruptures. A meta-analysis of randomized, controlled trials" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R.J.K. Khan" 1 => "D. Fick" 2 => "A. Keogh" 3 => "J. Crawford" 4 => "T. Brammar" 5 => "M. Parker" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2106/JBJS.D.03049" "Revista" => array:6 [ "tituloSerie" => "J Bone Joint Surg Am" "fecha" => "2005" "volumen" => "87" "paginaInicial" => "2202" "paginaFinal" => "2210" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16203884" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0190" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surgical interventions for treating acute Achilles tendon ruptures" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R.J. Khan" 1 => "R.L. Carey Smith" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Cochrane Database Syst Rev" "fecha" => "2010" "numero" => "9" "paginaInicial" => "CD003674" ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0195" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Deficits in heel-rise height and Achilles tendon elongation occur in patients recovering from an Achilles tendon rupture" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "K.G. Silbernagel" 1 => "R. Steele" 2 => "K. Manal" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/0363546512447926" "Revista" => array:6 [ "tituloSerie" => "Am J Sports Med" "fecha" => "2012" "volumen" => "40" "paginaInicial" => "1564" "paginaFinal" => "1571" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22593092" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0200" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Is percutaneous repair better than open repair in acute Achilles tendon rupture?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "H. Henríquez" 1 => "R. Muñoz" 2 => "G. Carcuro" 3 => "C. Bastías" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11999-011-1830-1" "Revista" => array:6 [ "tituloSerie" => "Clin Orthop Relat Res" "fecha" => "2012" "volumen" => "470" "paginaInicial" => "998" "paginaFinal" => "1003" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21365335" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0205" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mini-open tenorrhaphy of acute Achilles tendon ruptures: medium-term follow-up of 100 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Keller" 1 => "C. Ortiz" 2 => "E. Wagner" 3 => "P. Wagner" 4 => "P. Mococain" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/0363546513511418" "Revista" => array:6 [ "tituloSerie" => "Am J Sports Med" "fecha" => "2014" "volumen" => "42" "paginaInicial" => "731" "paginaFinal" => "736" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24318611" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0210" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prospective randomized clinical trial of aggressive rehabilitation after acute Achilles tendon ruptures repaired with Dresden technique" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C. De la Fuente" 1 => "R. Peña y Lillo" 2 => "G. Carreño" 3 => "H. Marambio" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "Foot (Edinb)" "fecha" => "2015" ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0215" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "History and evolution of the Kessler repair" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S.J. Sebastin" 1 => "A. Ho" 2 => "T. Karjalainen" 3 => "K.C. Chung" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jhsa.2012.11.033" "Revista" => array:6 [ "tituloSerie" => "J Hand Surg Am" "fecha" => "2013" "volumen" => "38" "paginaInicial" => "552" "paginaFinal" => "561" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23395342" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0220" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Augmentation of Achilles tendon repair with extracellular matrix xenograft: a biomechanical analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R. Magnussen" 1 => "R.R. Glisson" 2 => "C.T. Moorman" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/0363546510397815" "Revista" => array:6 [ "tituloSerie" => "Am J Sports Med" "fecha" => "2011" "volumen" => "39" "paginaInicial" => "1522" "paginaFinal" => "1527" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21372317" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0225" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acute rupture of the tendo calcaneus. Surgical repair with functional after treatment" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R.M. Crolla" 1 => "D.M. van Leeuwen" 2 => "B. van Ramshorst" 3 => "C. van der Werken" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Acta Orthop Belg" "fecha" => "1987" "volumen" => "53" "paginaInicial" => "492" "paginaFinal" => "494" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3324628" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0230" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A systematic review of early rehabilitation methods following a rupture of the Achilles tendon" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R.S. Kearney" 1 => "K.R. McGuinness" 2 => "J. Achten" 3 => "M.L. Costa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.physio.2011.04.349" "Revista" => array:6 [ "tituloSerie" => "Physiotherapy" "fecha" => "2012" "volumen" => "98" "paginaInicial" => "24" "paginaFinal" => "32" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22265382" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0235" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The role of multiple strands and locking sutures on gap formation of flexor tendon repairs during cyclical loading" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "K.A. Barrie" 1 => "S.L. Tomak" 2 => "J. Cholewicki" 3 => "S.W. Wolfe" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/jhsu.2000.9414" "Revista" => array:6 [ "tituloSerie" => "J Hand Surg Am" "fecha" => "2000" "volumen" => "25" "paginaInicial" => "714" "paginaFinal" => "720" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10913213" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0240" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The resistance of a four- and eight-strand suture technique to gap formation during tensile testing: an experimental study of repaired canine flexor tendons after 10 days of in vivo healing" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "H.T. Dinopoulos" 1 => "M.I. Boyer" 2 => "M.E. Burns" 3 => "R.H. Gelberman" 4 => "M.J. Silva" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/jhsu.2000.6456" "Revista" => array:6 [ "tituloSerie" => "J Hand Surg Am" "fecha" => "2000" "volumen" => "25" "paginaInicial" => "489" "paginaFinal" => "498" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10811754" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0245" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A comparative analysis of the six-strand double-loop flexor tendon repair and three other techniques: A human cadaveric study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R.S. Gill" 1 => "B.H. Lim" 2 => "R.A. Shatford" 3 => "E. Toth" 4 => "M.J. Voor" 5 => "T.M. Tsai" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/jhsu.1999.1315" "Revista" => array:6 [ "tituloSerie" => "J Hand Surg Am" "fecha" => "1999" "volumen" => "24" "paginaInicial" => "1315" "paginaFinal" => "1322" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10584960" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0250" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Biomechanical comparison of four methods of repair of the Achilles tendon: a laboratory study with bovine tendons" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Ortiz" 1 => "E. Wagner" 2 => "P. Mocoçain" 3 => "G. Labarca" 4 => "A. Keller" 5 => "A. del Buono" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1302/0301-620X.94B5.27642" "Revista" => array:6 [ "tituloSerie" => "J Bone Joint Surg Br" "fecha" => "2012" "volumen" => "94" "paginaInicial" => "663" "paginaFinal" => "667" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22529088" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0255" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Achilles tendon elongation after rupture repair: a randomized comparison of 2 postoperative regimens" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J. Kangas" 1 => "A. Pajala" 2 => "P. Ohtonen" 3 => "J. Leppilahti" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/0363546506293255" "Revista" => array:6 [ "tituloSerie" => "Am J Sports Med" "fecha" => "2007" "volumen" => "35" "paginaInicial" => "59" "paginaFinal" => "64" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16973901" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0260" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Percutaneous versus open repair of acute Achilles tendon ruptures" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "P.K. Karabinas" 1 => "I.S. Benetos" 2 => "K. Lampropoulou-Adamidou" 3 => "P. Romoudis" 4 => "A.F. Mavrogenis" 5 => "J. Vlamis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00590-013-1350-7" "Revista" => array:6 [ "tituloSerie" => "Eur J Orthop Surg Traumatol" "fecha" => "2014" "volumen" => "24" "paginaInicial" => "607" "paginaFinal" => "613" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24190345" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/19888856/0000006000000005/v1_201608210033/S1988885616300347/v1_201608210033/en/main.assets" "Apartado" => array:4 [ "identificador" => "7577" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/19888856/0000006000000005/v1_201608210033/S1988885616300347/v1_201608210033/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1988885616300347?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 1 | 0 | 1 |
| 2024 October | 37 | 9 | 46 |
| 2024 September | 40 | 8 | 48 |
| 2024 August | 35 | 4 | 39 |
| 2024 July | 26 | 8 | 34 |
| 2024 June | 23 | 2 | 25 |
| 2024 May | 16 | 6 | 22 |
| 2024 April | 36 | 5 | 41 |
| 2024 March | 27 | 11 | 38 |
| 2024 February | 23 | 8 | 31 |
| 2024 January | 46 | 5 | 51 |
| 2023 December | 22 | 5 | 27 |
| 2023 November | 21 | 8 | 29 |
| 2023 October | 27 | 12 | 39 |
| 2023 September | 35 | 5 | 40 |
| 2023 August | 28 | 3 | 31 |
| 2023 July | 49 | 5 | 54 |
| 2023 June | 40 | 7 | 47 |
| 2023 May | 65 | 10 | 75 |
| 2023 April | 75 | 4 | 79 |
| 2023 March | 51 | 12 | 63 |
| 2023 February | 39 | 4 | 43 |
| 2023 January | 56 | 7 | 63 |
| 2022 December | 62 | 17 | 79 |
| 2022 November | 68 | 9 | 77 |
| 2022 October | 86 | 9 | 95 |
| 2022 September | 62 | 17 | 79 |
| 2022 August | 39 | 12 | 51 |
| 2022 July | 21 | 10 | 31 |
| 2022 June | 21 | 13 | 34 |
| 2022 May | 31 | 11 | 42 |
| 2022 April | 34 | 14 | 48 |
| 2022 March | 57 | 10 | 67 |
| 2022 February | 67 | 7 | 74 |
| 2022 January | 47 | 12 | 59 |
| 2021 December | 28 | 11 | 39 |
| 2021 November | 46 | 13 | 59 |
| 2021 October | 41 | 15 | 56 |
| 2021 September | 34 | 17 | 51 |
| 2021 August | 32 | 16 | 48 |
| 2021 July | 18 | 10 | 28 |
| 2021 June | 16 | 6 | 22 |
| 2021 May | 28 | 8 | 36 |
| 2021 April | 36 | 33 | 69 |
| 2021 March | 19 | 7 | 26 |
| 2021 February | 13 | 11 | 24 |
| 2021 January | 10 | 1 | 11 |
| 2020 December | 1 | 0 | 1 |
| 2017 August | 1 | 0 | 1 |
Show all
