Proximal Patellar Tendon Repair: Internal Brace Technique With Unicortical Buttons and Suture Tape

Sánchez, George; Ferrari, Márcio B.; Sanchez, Anthony; Moatshe, Gilbert; Chahla, Jorge; DePhillipo, Nicholas N.; Provencher, Matthew T.

doi:10.1016/j.eats.2016.11.004

Cited by 20 publications

(15 citation statements)

References 28 publications

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“…Our observation has been confirmed by earlier experimental measurements on wounded ligaments, and threose treated cartilage, in which a clear positive correlation between crosslink density and tissue strength has been well documented 56,57 . Our predicted patterns of micro damage (plastic change) are in line with the previously reported ligament failure patterns 58‐64 . The patellar tendon was the only structure characterized by connective tissue–bone boundary failure, in which the fibers fail at the tendon‐bone junction without fracture of the underlying bone.…”

Section: Discussionsupporting

confidence: 90%

Multiscale modeling of knee ligament biomechanics

Adouni

Mbarki

Khatib

et al. 2020

Numer Methods Biomed Eng

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Knee connective tissues are mainly responsible for joint stability and play a crucial role in restraining excessive motion during regular activities. The damage mechanism of these tissues is directly linked to the microscale collagen level. However, this mechanical connection is still unclear. During this investigation, a multiscale fibril‐reinforced hyper‐elastoplastic model was developed and statistically calibrated. The model is accounting for the structural architecture of the soft tissue, starting from the tropocollagen molecule that forms fibrils to the whole soft tissue. Model predictions are in agreement with the results of experimental and numerical studies. Further, damage initiation and propagation in the collagen fiber were computed at knee ligaments and located mainly in the superficial layers. Results indicated higher crosslink density required higher tensile stress to elicit fibril damage. This approach is aligned with a realistic simulation of a damaging process and repair attempt. To the best of our knowledge, this is the first model published in which the connective tissue stiffness is simultaneously predicted by encompassing the mesoscopic scales between the molecular and macroscopic levels.

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Section: Discussionsupporting

confidence: 90%

Multiscale modeling of knee ligament biomechanics

Adouni

Mbarki

Khatib

et al. 2020

Numer Methods Biomed Eng

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“… 12 , 13 , 14 , 15 Suture augmentation repair has also been described with the standard Krackow transosseous technique for patellar tendon repair. 16 One biomechanical study found that the Krackow technique with high-strength suture tape augmentation was stronger than cerclage wire augmentation or the Krackow technique alone in repair of midsubstance patellar tendon rupture. 17 A separate technique article described a patellar tendon repair method using a high-strength suture tape construct with unicortical buttons for fixation.…”

Section: Introductionmentioning

confidence: 99%

“… 17 A separate technique article described a patellar tendon repair method using a high-strength suture tape construct with unicortical buttons for fixation. 16 However, the role of high-strength suture tape augmentation of the Krackow technique in the setting of inferior pole avulsion remains unclear. 18 …”

Section: Introductionmentioning

confidence: 99%

High-Strength Suture Tape Augmentation Improves Cyclic Gap Formation in Transosseous Patellar Tendon Repair: A Biomechanical Study

Gould

Weiner

Tomaszewski

et al. 2020

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose To compare gap displacement at various intervals of cyclic testing and biomechanical load to failure of a Krackow patellar tendon repair augmented with high-strength suture tape versus the standard Krackow transosseous technique for inferior pole patellar tendon rupture. Methods Twelve matched pairs of cadaveric knees were used (8 males and 4 females; mean age 79.6 years, range 57 to 96). An inferior pole patellar tendon rupture was simulated after random assignment of specimens in each pair to the standard or augmented Krackow technique. Each specimen was then repetitively cycled from 90° to 5° for 1,000 cycles. A differential variable reluctance transducer was used to measure gap displacement. After cyclic loading, load to failure was determined by pulling the tendon at a rate of 15 mm/s until a sudden decrease in load occurred. Results Compared with the control repair, specimens with augmented repair demonstrated significantly less displacement at all testing intervals up to 1,000 cycles ( P < .05). Two patellar tendons failed before the end of cyclic loading, and 4 specimens had inadequate tendon length for loading. Among the 18 remaining specimens, no significant difference in load to failure was observed between the experimental group (n = 11) and the control group (n = 7) (1,006.5 ± 332.1 versus 932.8 ± 229.1 N, respectively; P = .567). Conclusions Significantly greater gap displacement was observed in the standard Krackow repair group compared with the augmented Krackow group at all cyclic loading intervals. This suggests that the Krackow transosseous procedure augmented with high-strength suture tape is biomechanically viable for inferior pole patellar tendon repair. Clinical Relevance This biomechanical study supports the use of high-strength suture tape augmentation of Krackow transosseous repair for inferior pole patellar tendon rupture.

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“…Another group of knee surgeons published a surgical technique also advocating the use of suture tape as reinforcement in the reconstruction of the patellar tendon, suggesting better results with the tape. 27 Reconstruction of the patellar tendon using adjustable suspensory fixation has been reported for the treatment of chronic lesions. 28 The authors of this technique advocated the use of autologous semitendinosus and gracilis grafts.…”

Section: Discussionmentioning

confidence: 99%

Surgical Treatment for Chronic Rupture of the Patellar Tendon Performed in 2 Stages

Faria

Carvalho

Marques

et al. 2020

Arthroscopy Techniques

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Patellar tendon rupture is an uncommon but disabling lesion. It usually occurs in men younger than 40 years, through direct or indirect trauma. Obtaining satisfactory results with treatment of chronic injuries and re-ruptures in which the patella retracts owing to quadriceps contraction is a challenge. This is of major concern especially in cases in which the patella cannot be positioned in its anatomic position when distal traction is performed. In these cases, V-Y stretching of the quadriceps can be performed in an attempt to perform reconstruction in 1 stage. Instead, a 2-stage procedure can be chosen, in which the first stage relies on patellar trans-skeletal traction to achieve distalization of the patella. In 1981, a technique for the treatment of chronic injuries of the patellar tendon in 2 stages was described. In that procedure, the first stage consisted of transpatellar traction and the second stage was tendon-tendon suturing with fascia lata reinforcement. We describe a surgical technique performed in 2 stages; in the first stage, trans-skeletal traction is performed, and in the second stage, the technique of Kelikian et al. with our modification is performed. This technique is used in patients with chronic rupture of the patellar tendon associated with a high patella with nonreducible quadriceps shortening.

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Proximal Patellar Tendon Repair: Internal Brace Technique With Unicortical Buttons and Suture Tape

Cited by 20 publications

References 28 publications

Multiscale modeling of knee ligament biomechanics

Multiscale modeling of knee ligament biomechanics

High-Strength Suture Tape Augmentation Improves Cyclic Gap Formation in Transosseous Patellar Tendon Repair: A Biomechanical Study

Surgical Treatment for Chronic Rupture of the Patellar Tendon Performed in 2 Stages

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