Quadriceps Tendon Rupture: A Biomechanical Comparison of Transosseous Equivalent Double-Row Suture Anchor Versus Transosseous Tunnel Repair

Abstract

Quadriceps rupture off the patella is traditionally repaired by a transosseous tunnel technique, although a single-row suture anchor repair has recently been described. This study biomechanically tested a new transosseous equivalent (TE) double-row suture anchor technique compared with the transosseous repair for quadriceps repair. After simulated quadriceps-patella avulsion in 10 matched cadaveric knees, repairs were completed by either a three tunnel transosseous (TT = 5) or a TE suture anchor (TE = 5) technique. Double-row repairs were done using two 5.5 Bio-Corkscrew FT (fully threaded) (Arthrex, Inc., Naples, FL, USA) and two 3.5 Bio-PushLock anchors (Arthrex, Inc., Naples, FL, USA) with all 10 repairs done with #2 FiberWire suture (Arthrex, Inc., Naples, FL). Cyclic testing from 50 to 250 N for 250 cycles and pull to failure load (1 mm/s) were undertaken. Gap formation and ultimate tensile load (N) were recorded and stiffness data (N/mm) were calculated. Statistical analysis was performed using a Mann-Whitney U test and survival characteristics examined with Kaplan-Meier test. No significant difference was found between the TE and TT groups in stiffness (TE = 134 +/- 15 N/mm, TT = 132 +/- 26 N/mm, p = 0.28). The TE group had significantly less ultimate tensile load (N) compared with the TT group (TE = 447 +/- 86 N, TT = 591 +/- 84 N, p = 0.04), with all failures occurring at the suture eyelets. Although both quadriceps repairs were sufficiently strong, the transosseous repairs were stronger than the TE suture anchor repairs. The repair stiffness and gap formation were similar between the groups.

Quadriceps tendon tear rupture in healthy patients treated with patellar drilling holes: clinical and ultrasonographic analysis after 36 months of follow-up

“…Biomechanical studies were performed and showed no significant difference between anchor repair and patellar drilling holes technique 27 . Hart investigated biomechanical differences between trans-osseous equivalent double-row suture anchor and trans-osseous tunnel repair: he reported that both were effective in terms of strength, repair stiffness and gap formation with similar results, but the transosseous repairs were stronger 28 . Lighthart et al found no significant differences in terms of displacement after 1000 cycles, adding that suture anchors are more expensive but, as confirmed also by Richards et al 24 , Maniscalco et al 25 and Bushnell et al 26 , allow a smaller skin incision and reduce operative times 29 .…”

Reconstruction of a quadriceps tendon tear using Polyvinylidene fluoride sutures and patellar screw fixation: A biomechanical study

“…Although Lighthart et al as well as Hart et al published biomechanical studies comparing two different types of reconstruction, their analysis did not overlap with our own due to different materials that were used [37,39]. The "gold standard", transosseous repair, results in an extended length of suture over clinical course.…”

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

“…Quadriceps tendon rupture is an uncommon clinical entity that requires early surgical management. [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.…”

“…[2][3][4]8,9 The standard of care is repair with a nonabsorbable suture passed through transosseous patellar tunnels, often with several weeks of postoperative immobilization to protect the repair. 3,4,7,[10][11][12] Reported complications of this method include significant extension lag, decreased strength, and ROM compared with the contralateral knee, chronic pain, and iatrogenic patellar fracture. 8,[13][14][15][16][17][18] Repair techniques using suture anchors have been proposed as viable alternatives, but biomechanical studies comparing them with standard transosseous repair have reported mixed results.…”

“…8,[13][14][15][16][17][18] Repair techniques using suture anchors have been proposed as viable alternatives, but biomechanical studies comparing them with standard transosseous repair have reported mixed results. 7,[10][11][12][18][19][20] Two studies found improved biomechanical characteristics with suture anchors, 10,21 but 2 others found the characteristics of suture anchor fixation equal to 11 or worse than 12 those of transosseous fixation.…”