Knotless Suture Anchor With Suture Tape Quadriceps Tendon Repair Is Biomechanically Superior to Transosseous and Traditional Suture Anchor–Based Repairs in a Cadaveric Model

Recently, although some studies of open repair of the tendon of the quadriceps femoris have been published, there have been no reports in the literature on primary arthroscopic repair. In our present study, we present two cases of quadriceps tendon injury arthroscopically repaired with excellent results. Case 1 involved a 68-year-old man who was injured while shifting his weight to prevent a fall. MRI showed complete rupture at the insertion of the patella of the quadriceps tendon. The rupture was arthroscopically repaired using both suture anchor and pull-out suture fixation methods via bone tunnels (hereafter, pull-out fixation). Two years after surgery, retearing was not observed on MRI and both Japan Orthopedic Association (JOA) Knee and Lysholm scores had recovered to 100. Case 2 involved a 50-year-old man who was also injured when shifting his weight to prevent a fall. MRI showed incomplete superficial rupture at the insertion of the patella of the quadriceps tendon. The rupture was arthroscopically repaired using pull-out fixation of six strand sutures. One year after surgery, MRI revealed a healed tendon and his JOA and Lysholm scores were 95 and 100, respectively. Thus, arthroscopic repair may be a useful surgical method for repairing quadriceps tendon injury.

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Suture Tape Reduces Quadriceps Tendon Repair Gap Formation Compared With High-Strength Suture: A Cadaveric Biomechanical Analysis

Arthroscopy The Journal of Arthroscopic and Related Surgery ◽

10.1016/j.arthro.2020.04.020 ◽

2020 ◽

Vol 36 (8) ◽

pp. 2260-2267

Author(s):

Philip P. Roessler ◽

Timothy A. Burkhart ◽

Alan Getgood ◽

Ryan M. Degen

Keyword(s):

Tendon Repair ◽

High Strength ◽

Quadriceps Tendon ◽

Biomechanical Analysis ◽

Gap Formation ◽

Suture Tape

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Self-Tensioning Feature of Knotless Suture Anchor Provides Reproducible Knotless Fixation Independent of Initial Tension

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121991593 ◽

2021 ◽

Vol 9 (3) ◽

pp. 232596712199159

Author(s):

Aravind Athiviraham ◽

Cody S. Lee ◽

Patrick A. Smith ◽

Marina Piepenbrink ◽

Alexander P. Mackin ◽

...

Keyword(s):

Acl Reconstruction ◽

Porcine Model ◽

Suture Anchor ◽

Cruciate Ligament ◽

Testing Machine ◽

Time Data ◽

Postoperative Rehabilitation ◽

Initial Tension ◽

Knotless Suture Anchor ◽

Suture Tape

Background: Anterior cruciate ligament (ACL) reconstruction with suture tape reinforcement has been shown to biomechanically reduce elongation and increase ultimate strength. However, the amount and consistency of the achieved tension after primary fixation using knotless suture anchors remains unclear. Purpose: To determine whether initial tensioning of suture tape before fixation with a knotless suture anchor significantly affects final tension of the suture tape. Study Design: Controlled laboratory study. Methods: We secured 15 pairs of Sawbones blocks with predrilled tunnels to a tensile testing machine. Suture tape was inserted through a suspensory fixation button on the representative femoral block and threaded top-down through the base of the tibial block over an attachable button system. The suture tape was attached with a knotless suture anchor in a predrilled and tapped hole on the tibial block under the following pretensioning conditions: (1) slight tension of 5 N, (2) no tension, and (3) initial slack. The suture anchor was inserted as the load-time data were recorded. After initial block testing, a porcine model of 24 tibias was used to test the same pretensioning conditions. The initial loads during anchor insertion and screw-in were measured, as well as final tension. Results: During block testing, no difference in final tensioning was found when comparing the slight-tension, no-tension, and slack groups (42.3 ± 5.3, 37.7 ± 6.4, and 40.2 ± 7.0 N, respectively; P = .528). Similar to block testing, no difference in final tensioning was found when comparing the slight-tension, no-tension, and slack groups using the porcine model (43.64 ± 6.69, 48.09 ± 13.93, and 44.52 ± 6.84 N, respectively; P = .633). Conclusion: The final tension of the suture tape construct appears to be reproducible and consistent, independent of the initial tension introduced with suture anchor placement within the tested parameters. Clinical Relevance: The results of the current study can help optimize the placement technique of independent suture tape reinforcement for ACL reconstruction, which is a promising strategy to help prevent ACL rerupture, particularly in the early phases of postoperative rehabilitation.

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Adjustable Cortical Fixation Device for Quadriceps Tendon Repair: A Cadaveric Biomechanical Study

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120974393 ◽

2021 ◽

Vol 9 (1) ◽

pp. 232596712097439

Author(s):

Heath P. Gould ◽

William R. Rate ◽

Pooyan Abbasi ◽

Katherine L. Mistretta ◽

Jason W. Hammond

Keyword(s):

Cyclic Loading ◽

Suture Anchor ◽

Tendon Repair ◽

Quadriceps Tendon ◽

Fixation Device ◽

Peak Displacement ◽

Anchor Group ◽

Fixation Group ◽

The Mean ◽

Suture Anchor Repair

Background: Adjustable cortical fixation devices have demonstrated utility in orthopaedic applications, such as ankle syndesmosis repair. Purpose: To assess the cyclic gap formation of a quadriceps tendon repair technique using an adjustable cortical fixation device compared with repair with knotless suture anchors and suture tape, a modification of conventional suture anchor repair. Study Design: Controlled laboratory study. Methods: Eight fresh-frozen matched pairs of cadaveric knees were used. Specimens in each pair were randomized to undergo either modified suture anchor repair (control) or adjustable cortical fixation repair. The control repair was performed as previously described. The experimental repair was performed using 2 No. 2 FiberWire sutures placed into the quadriceps tendon in a running locked Krackow configuration and 2 adjustable loop devices passed through transosseous tunnels. The lagging strands of the devices were tensioned to seat the cortical fixation buttons at the inferior patellar pole and then tied to the free Krackow strands at the superior pole to complete the repair. The mean plastic gap (permanent tendon displacement that did not recover with cyclic extension) and mean maximum gap (peak displacement that occurred with cyclic knee flexion and partially recovered with extension) were evaluated during cyclic loading for 500 cycles of full knee extension to 90° of flexion. Results: At all testing intervals, the mean plastic gap was significantly smaller for the cortical fixation group versus the suture anchor group ( P < .02). Similarly, the mean maximum gap was significantly smaller for the cortical fixation specimens at all testing intervals ( P < .01). After cyclic loading, the mean maximum gap was significantly smaller in the cortical fixation group (4.80 ± 1.56 mm) versus the suture anchor group (8.47 ± 1.47 mm; P = < .001). The mean plastic gap was also significantly smaller in the cortical fixation versus the suture anchor group (3.25 ± 1.10 mm vs 6.57 ± 1.62 mm, respectively; P = < .001). Conclusion: Quadriceps tendon repair using an adjustable cortical fixation device demonstrated superior biomechanical properties in cyclic displacement testing compared with repair using the suture anchor technique. Clinical Relevance: These results suggest that an adjustable cortical fixation device is a biomechanically viable alternative for quadriceps tendon repair.

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01 - Comparing Clinical Outcomes Between Transosseous Patellar Suture Fixation Versus Suture Anchor Repair in the Treatment of Quadriceps Tendon Repair

10.26226/morressier.5cffabaef6074e97f94aae3b ◽

2019 ◽

Author(s):

Muhammad Mutawakkil ◽

Sohaib Hashmi

Keyword(s):

Clinical Outcomes ◽

Suture Anchor ◽

Tendon Repair ◽

Quadriceps Tendon ◽

Suture Fixation ◽

Suture Anchor Repair

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Quadriceps Tendon Repair Using Knotless Anchors and Suture Tape

Arthroscopy Techniques ◽

10.1016/j.eats.2017.06.013 ◽

2017 ◽

Vol 6 (5) ◽

pp. e1541-e1545 ◽

Cited By ~ 1

Author(s):

Michael H. Amini

Keyword(s):

Tendon Repair ◽

Quadriceps Tendon ◽

Suture Tape

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Patellar Tendon Repair Augmentation With a Knotless Suture Anchor Internal Brace: A Biomechanical Cadaveric Study

The American Journal of Sports Medicine ◽

10.1177/0363546517751916 ◽

2018 ◽

Vol 46 (5) ◽

pp. 1199-1204 ◽

Cited By ~ 4

Author(s):

Alex Rothfeld ◽

Amanda Pawlak ◽

Stephenie A.H. Liebler ◽

Michael Morris ◽

James M. Paci

Keyword(s):

Patellar Tendon ◽

Suture Anchor ◽

Primary Repair ◽

Tendon Repair ◽

Maximum Load ◽

Yield Load ◽

Cerclage Wire ◽

Internal Brace ◽

Group 2 ◽

Knotless Suture Anchor

Background: Patellar tendon repair with braided polyethylene suture alone is subject to knot slippage and failure. Several techniques to augment the primary repair have been described. Purpose/Hypothesis: The purpose was to evaluate a novel patellar tendon repair technique augmented with a knotless suture anchor internal brace with suture tape (SAIB). The hypothesis was that this technique would be biomechanically superior to a nonaugmented repair and equivalent to a standard augmentation with an 18-gauge steel wire. Study Design: Controlled laboratory study. Methods: Midsubstance patellar tendon tears were created in 32 human cadaveric knees. Two comparison groups were created. Group 1 compared #2 supersuture repair without augmentation to #2 supersuture repair with SAIB augmentation. Group 2 compared #2 supersuture repair with an 18-gauge stainless steel cerclage wire augmentation to #2 supersuture repair with SAIB augmentation. The specimens were potted and biomechanically loaded on a materials testing machine. Yield load, maximum load, mode of failure, plastic displacement, elastic displacement, and total displacement were calculated for each sample. Standard statistical analysis was performed. Results: There was a statistically significant increase in the mean ± SD yield load and maximum load in the SAIB augmentation group compared with supersuture alone (mean yield load: 646 ± 202 N vs 229 ± 60 N; mean maximum load: 868 ± 162 N vs 365 ± 54 N; P < .001). Group 2 showed no statistically significant differences between the augmented repairs (mean yield load: 495 ± 213 N vs 566 ± 172 N; P = .476; mean maximum load: 737 ± 210 N vs 697 ± 130 N; P = .721). Conclusion: Patellar tendon repair augmented with SAIB is biomechanically superior to repair without augmentation and is equivalent to repair with augmentation with an 18-gauge stainless steel cerclage wire. Clinical Relevance: This novel patellar tendon repair augmentation is equivalent to standard 18-gauge wire augmentation at time zero. It does not require a second surgery for removal, and it is biomechanically superior to primary repair alone.

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