Biomechanical Evaluation of Suture Anchor Versus Transosseous Tunnel Quadriceps Tendon Repair Techniques

Knotless Tape Suture Fixation of Quadriceps Tendon Rupture: A Novel Technique

“…[1][2][3][4][5]12,17,19 The standard of care is passage of nonabsorbable sutures through transosseous patellar bone tunnels, but repair with suture anchors has been studied as an alternative that allows for less tissue trauma, decreased operative time, safe early initiation of rehabilitation protocols, and reduced risk of patella fracture or damage. 3,7,[10][11][12][18][19][20]21,23 Despite these potential advantages, biomechanical studies have yielded inconsistent results regarding the superiority of suture anchor repair over repair with transosseous tunnels. 7,[10][11][12][18][19][20] We propose quadriceps tendon repair using the 4.75-mm biocomposite knotless suture anchor with tape suture technique as a biomechanically superior alternative to either transosseous tunnels or suture anchor repair alone, with significant advantages both in and out of the operating room.…”

“…Results of biomechanical studies comparing transosseous tunnel repair and standard suture anchor repair have been mixed, though the heterogeneity of their study methods and endpoints makes direct comparisons difficult. 7,[10][11][12][18][19][20] Petri and colleagues 10 and Sherman and colleagues 21 reported statistically significant higher load to failure 10 and reduced gapping during cyclic loading 10,21 with suture anchor repair relative to transosseous repair.…”

“…22 Similarly to standard repair with suture anchors, repair using a 4.75-mm biocomposite knotless suture anchor with tape suture eliminates the need to expose the distal pole of the patella. 7,[10][11][12]21 This allows for a smaller surgical incision, less extensive dissection, and prevents possible interference with the patellar tendon. 7,[10][11][12]21 Additionally, it eliminates the risk of iatrogenic patellar fracture and damage to the articular surface from drilling the transpatellar tunnels.…”

“…7,[10][11][12]21 This allows for a smaller surgical incision, less extensive dissection, and prevents possible interference with the patellar tendon. 7,[10][11][12]21 Additionally, it eliminates the risk of iatrogenic patellar fracture and damage to the articular surface from drilling the transpatellar tunnels. 17,18 Both our own review of cases repaired with our 4.75-mm biocomposite knotless suture anchor with suture tape technique as well as studies of suture anchor repair have consistently found operative times of <1 hour.…”

“…17,18 Both our own review of cases repaired with our 4.75-mm biocomposite knotless suture anchor with suture tape technique as well as studies of suture anchor repair have consistently found operative times of <1 hour. 21 Shorter operative times and smaller surgical wounds are advantageous given that many of these patients have medical comorbidities that predispose them to intraoperative and wound-healing complications. 12,[19][20][21][22] Optimal rehabilitation protocols for quadriceps tendon repair are a matter of controversy.…”