Biomechanical Testing of Suture Anchor Versus Transosseous Tunnel Technique for Quadriceps Tendon Repair Yields Similar Outcomes: A Systematic Review

Abstract

Purpose: To systematically review the literature to evaluate the biomechanical properties of the suture anchor (SA) versus transosseous tunnel (TO) techniques for quadriceps tendon (QT) repair. Methods: A systematic review was performed by searching PubMed, the Cochrane Library, and Embase using PRISMA guidelines to identify studies that evaluated the biomechanical properties of SA and TO techniques for repair of a ruptured QT. The search phrase used was "quadriceps tendon repair biomechanics". Evaluated properties included ultimate load to failure (N), displacement (mm), stiffness (N/mm), and mode of failure. Results: Five studies met inclusion criteria, including a total of 72 specimens undergoing QT repair via the SA technique and 42 via the TO technique. Three of 4 studies found QTs repaired with SA to have significantly less elongation upon initial cyclic loading when compared to QTs repaired with the TO technique (P < .05). Three of 5 studies found QTs repaired with SA to have significantly less elongation upon final cyclic loading when compared to QTs repaired with the TO technique (P < .05). The pooled analysis from 4 studies reporting on initial displacement showed a statistically significant difference in favor of the SA group compared to the TO group (P ¼ .03). The pooled analysis from studies reporting on secondary displacement and ultimate load to failure showed no significant difference between the SA and TO groups (P > .05). The most common mode of failure in both groups was suture slippage. Conclusion: On the basis of the included cadaveric studies, QTs repaired via the SA technique have less initial displacement upon cyclic testing when compared to QTs repaired via the TO technique. However, final displacement and ultimate load to failure outcomes did not reveal differences between the two fixation strategies. Knot slippage remains a common failure method for both strategies.

Quadriceps tendon repair using double row suture anchor fixation: Case reports and review of the literature

“…Numerous cadaveric biomechanical studies have shown the superiority of the single or double anchor method. Apart from the limited number of cases in our study, the use of double row anchors in the treatment of acute quadricipital tendon ruptures seems to be an attractive technique with excellent medium-term results noted in our study, so a larger sample with consequent hindsight will make it possible to confirm the place of this technique in this pathology [1] , [4] , [8] , [12] , [13] , [14] .…”

Suture Bridge Transosseous Quadriceps Tendon Repair for Spontaneous Quadriceps Tendon Rupture in Patients With End-Stage Renal Disease

“…When compared with constructs repaired by the TT technique, tendon displacement on initial cycling is consistently lower for SA fixation constructs, according to a systematic review. 18 Between the SA and TT groups, no significant differences in construct stiffness or modes of failure were observed. Regarding modes of failure, knot slippage was the most common mode for both the TT and SA techniques.…”

“…The modes of failure in the TT group were knot slippage (38.7%), suture tearing through tendon (32.3%), and suture breakage at knots (29.0%). 18 …”

Do Patellar Tendon Repairs Have Better Outcomes than Quadriceps Tendon Repairs? A Prospective Cohort Analysis

“…A recent systematic review on biomechanical comparison studies of both techniques reported similar ultimate load to failure and final displacement. 46 However, another recent systematic review reported smaller gap formations after both quadriceps and PT ruptures in suture anchor fixation compared with transosseous tunnel technique. 47 Mehta et al reported improved ROM and lower complication rates for transosseous tunnel technique, and similar Lysholm scores and re-rupture rates in a systematic review.…”