2-Octyl Cyanoacrylate Adjuvant Use in Calcaneal Tendon Repair: Comparative Experimental Study in Rabbits

Abstract

Category: Basic Sciences/Biologics; Ankle; Sports Introduction/Purpose: The best alternative for treating calcaneal tendon rupture is still controversial. The treatment can be conservative or surgical; the latter is better indicated in high-performance athletes. The pursue of faster recovery, reductions in skin complications and re-ruptures have brought about improvements to the tendon repair technique and to early assisted rehabilitation programs. Our goal was to check whether or not the adjuvant use of 2-octyl cyanoacrylate provides additional mechanical resistance to the calcaneal tenorraphy, when compared to suture alone, using the same tenorraphy technique. Methods: We used 45 three-month-old New Zealand rabbits, distributed into three groups of 15 animals each. The rabbits underwent two surgical procedures at a 30-day interval. In the first procedure, we performed the complete calcaneal tendon section on the right side, and then we repaired it using three different techniques: suture alone in group 1, suture with 2-octyl cyanoacrylate in group 2, and 2-octyl cyanoacrylate alone in group 3. After 30 days, we slaughtered the rabbits, and resected their right-side calcaneal tendon, and sent the specimen for pathology analysis. Then, we performed a cross section of the left calcaneal tendon, and used the same three repair techniques. After 15 minutes, we subjected the repaired tendons to the linear traction mechanical strength test. Results: The results from the linear strength test showed that suture with glue outperformed suture alone (p = 0.0427), and glue alone (p <0.0001). There was no rupture pattern difference between the groups, whether due to suture rupture or slipping. The pathology results were evaluated according to inflammation, repair process and tendon thickness. The report mentioned a high- intensity mixed inflammatory pattern (acute and chronic), outstanding neovascularization, tissue necrosis and abscess in most of the cases that used cyanoacrylate. However, there were no local or systemic clinical signs of an infectious process, or difference in tendon thickness between the three groups. Conclusion: 2-octyl cyanoacrylate added immediate mechanical strength to the calcaneal tendon repair in the rabbits, without increasing local complications, despite pathological changes (focal necrosis, microabscesses and granulomatous reaction) in up to 30 days after the repair.