Failure Rates of Suture Anchor Fixation Versus Transosseous Tunnel Technique for Patellar Tendon Repair: A Systematic Review and Meta-analysis of Biomechanical Studies

Abstract

Background: Transosseous tunnel (TO) repair is considered the gold standard for patellar tendon rupture; however, suture anchor (SA) repair has emerged as a viable alternative in recent years. Although both these techniques are used widely in clinical practice, the most biomechanically optimal construct for patellar tendon repair remains unknown. Purpose: To examine published studies on the biomechanical properties of TO and SA fixation for patellar tendon repair in terms of ultimate load to failure and cyclic gap formation. The null hypothesis was that there would be no significant difference in either outcome measure between the groups. Study Design: Systematic review. Methods: A systematic review using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed by searching PubMed, the Cochrane Library, and Embase to identify studies that analyzed the biomechanical properties of SA and TO techniques for repair of a ruptured patellar tendon. The search phrase implemented was “patellar tendon repair.” Meta-analysis was performed to provide a quantitative comparison of the 2 techniques with regard to ultimate load to failure and cyclic gap displacement. Weighted averages were calculated for all quantitative outcomes, and outcomes were summarized in a forest plot. A random-effects model was used to account for the heterogeneity among the included studies in the final statistical analysis. Results: Of 875 studies initially screened, the inclusion criteria were met by 7 studies, including 128 cadaveric specimens (66 SA, 62 TO). The pooled analysis from 6 studies reporting on gap displacement revealed a statistically significant difference in favor of SA versus TO fixation ( P < .001). Pooled analysis from 7 studies reporting on ultimate load to failure did not reveal a statistically significant difference between the use of SA and TO for tendon repair ( P = .465). Conclusion: Our systematic review revealed that the use of SA fixation for patellar tendon repair was associated with lower cyclic gap displacement when compared with TO fixation. There was no significant difference in ultimate load to failure between the repair techniques.

Osteosynthesis of a patellar fracture with repair of the knee extensor mechanism: Case report

“…Imbergamo et al performed a systematic review using PRISMA guidelines, searching PubMed, the Cochrane Library, and Embase to identify studies that analyzed the biomechanical properties of SA and TO techniques for repair of a ruptured patellar tendon, resulting that the use of SA fixation results in decreased cyclic gap formation when compared with TO repair, with no significant difference in ultimate load to failure between the groups. These findings may have meaningful clinical implications, coinciding with existing clinical data demonstrating a decreased failure rate for SA repair in comparison with TO repair for patellar tendon rupture [ 11 ]. Both patellar and quadriceps tendon ruptures are significant cause of morbidity and can have negative short- and long-term effects on patient lives [ 12 ].…”

Acute Patellar Tendon Ruptures: An Update on Management

“…These findings were further corroborated by Lanzi et al 54 in a study on 24 porcine specimens that found markedly less gap formation and higher load to failure with suture anchor versus transosseous tunnels. In a systematic review and meta-analysis of seven studies and a total of 128 cadaveric knees, Imbergamo et al 32 found markedly less gap formation in the suture anchor cohort but did not reveal any notable difference in ultimate load to failure. In a separate meta-analysis, suture anchors again demonstrated favorable biomechanical properties in terms of gap formation when compared with transosseous tunnels.…”

“…Although many repair techniques have been reported, repair with transosseous tunnels is the most popular. 31 , 32 This technique typically includes two to four bone tunnels through which sutures are passed and tied (Figures 4 and 5 ). Suture fixation into the tendon is critical for adequate repair, and various suture techniques have been reported.…”

Rotura bilateral aguda de tendón patelar en paciente sin factores de riesgo. Reporte de caso y revisión de la literatura

“…41 Sin embargo, cada vez hay más evidencia a favor de las anclas sin importar la zona de la lesión. 42 Además, el estudio de O'Dowd y asociados demostró que la reparación con anclas presenta disminución significativa en la tasa de rerrotura, en comparación con la reparación de túneles transóseos. 43 Los cerclajes metálicos protegen la reparación primaria y aumentan la estabilidad de la construcción, disminuyendo la separación en el sitio de reparación y pueden permitir un rango de movimiento más rápido.…”