Outcomes following quadriceps tendon repair using transosseous tunnels versus suture anchors: A systematic review

Early, Bilateral Re-Rupture of Quadriceps Tendon After Previous Bone-Anchor Repair for Simultaneous, Low-Energy, Bilateral Quadriceps Rupture: A Case Report and Literature Review

“…Similarly, Tucker and Jones [ 23 ] reported on 3 obese patients who sustained bilateral quadriceps tendon ruptures and found that the suture anchor-based construct allowed for a secure repair, early initiation of physical therapy, and a noted improvement in pain scores on the Visual Analog Scale. In contrast, Mehta et al [ 24 ], in a recent systematic review of clinical outcomes after repair of quadriceps ruptures using sutures or anchors, showed no significant differences in functional outcome between these techniques but a statistically significantly greater final ROM with suture repair. There was also a statistically significantly higher rate of postoperative complications using suture anchor technique, but not a significant difference in re-rupture rate.…”

“…Our case is unique, not only because of the absence of an underlying disease, obesity or medications, but also due to the early bilateral and low-energy re-rupture that happened as soon as the patient returned to his daily living activities (3.5 months postoperatively). The reason for this failure may have been the use of bone anchors, but they have been proved equal to or superior to transosseous suturing in terms of pull-out strength in both cadaveric and clinical studies; they also allow less surgical time, smaller incision, absence of non-absorbable material at the apex of the patella, less incidence of patella fractures, and smaller dead-length of sutures, thus facilitating early rehabilitation [ 20 – 24 ]. In our patient, we used fully threaded titanium anchors (except for 1 Mitec GII), showing high pull-out strength and resistance to failure in various studies.…”

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

“… 19 Interestingly, quadriceps ruptures typically occur around the enthesis rather than the biomechanically weakest point: the myo-tendinous junction. 11 , 20 Bone-tendon failure may be due to abnormal cellular structure at the rupture site. Kannus et al 21 evaluated 891 spontaneous ruptures (82 quadriceps ruptures) and found abnormalities of hypoxic degenerative tendinopathy, mucoid degeneration, tendolipomatosis, and calcifying tendinopathy in nearly all biopsies taken at the time of repair.…”

“…Although this technique has been associated with decreased operative times and requires decreased blood supply disruption, 10 the reliance on the suture anchors for initial fixation strength has been a deterrent for many surgeons due to its increased complication rates. 11 Multiple biomechanical studies [12][13][14][15][16] comparing these two techniques for QT repair have been previously described; however, the biomechanical superiority of one technique over the other has yet to be investigated in a comprehensive review. The purpose of this study is to systematically review the literature to evaluate the biomechanical properties of the SA versus TO techniques for QT repair.…”

“…Although this technique has been associated with decreased operative times and requires decreased blood supply disruption, 10 the reliance on the suture anchors for initial fixation strength has been a deterrent for many surgeons due to its increased complication rates. 11 …”