Abstract
PurposeTo systematically review the literature to evaluate the biomechanical properties of the suture anchor (SA) versus transosseous tunnel (TO) techniques for quadriceps tendon (QT) repair.MethodsA 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.ResultsFive 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 = .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.ConclusionOn 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.
Highlights
Quadriceps tendon (QT) ruptures are debilitating injuries that severely compromise knee function and ambulation.[1,2]. These injuries typically occur in patients older than 50 and while typically associated with either trauma or steroid use,[3] they have been associated with underlying medical conditions, including obesity, systemic illnesses, and renal dysfunction that may compromise the structural integrity of tendinous tissue.[2,4,5]
A total of 146 studies were reviewed by title and/or abstract to determine study eligibility based on inclusion criteria
The sex for cadaveric specimens was not recorded in any study
Summary
Quadriceps tendon (QT) ruptures are debilitating injuries that severely compromise knee function and ambulation.[1,2] These injuries typically occur in patients older than 50 and while typically associated with either trauma or steroid use,[3] they have been associated with underlying medical conditions, including obesity, systemic illnesses, and renal dysfunction that may compromise the structural integrity of tendinous tissue.[2,4,5] Overall, these injuries remain fairly uncommon, with an incidence of just over 1/100,000 patients per year.[4]. S.M. is a paid consultant for Styker. J.G is a paid consultant for Pivot and Stryker. J.D. is a paid consultant for Beckman Disckenson, Biomet, Breg, CONMED Linvatec, DePuy, DJ Orthopaedics, Genzyme, Harvest Tecyhnologies, Joint Restoration Foundation, KcRN Research, Ossur, Regeeneration Technologies, Inc., RNL Bio, Sideline Sports Docs, and Zimmer. He is a board member of AAOS, AJSM, AOSSM, AANA, and the PAC12 Athletic Conference. Full ICMJE author disclosure forms are available for this article online, as supplementary material
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