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Knee Surg Sports Traumatol Arthrosc (2015) 23:10391045 DOI 10.1007/s00167-014-2854-3
KNEE
Suture anchor repair yields better biomechanical properties than transosseous sutures in ruptured quadriceps tendons
M. Petri A. Dratzidis S. Brand T. Calliess
C. Hurschler C. Krettek M. Jagodzinski
M. Ettinger
Received: 2 September 2013 / Accepted: 12 January 2014 / Published online: 29 January 2014 Springer-Verlag Berlin Heidelberg 2014
AbstractPurpose This human cadaveric study compares the bio-mechanical properties of quadriceps tendon repair with suture anchors and the commonly applied transosseous sutures. The hypothesis was that suture anchors provide at least equal results concerning gap formation and ultimate failure load compared with transosseous suture repair. Methods Thirty human cadaveric knees underwent tenotomy followed by repair with either 5.5-mm-double-loaded suture anchors [titanium (TA) vs. resorbable hydroxyapatite (HA)] or transpatellar suture tunnels using No. 2 UltrabraidTM and the Krackow whipstitch. Biomechanical analysis included pretensioning the constructs with 20 N for 30 s and then cyclic loading of 250 cycles between 20 and 100 N at 1 Hz in a servohydraulic testing machine with measurement of elongation. Ultimate failure load analysis and failure mode analysis were performed subsequently.
Results Tendon repairs with suture anchors yielded signicantly less gap formation during cyclic loading (20th 250th cycle: TA 1.9 0.1, HA 1.5 0.5, TS33.3 1.9 mm, p \ 0.05) and resisted signicantly higher
ultimate failure loads (TA 740 204 N, HA 572 67 N, TS 338 60 N, p \ 0.05) compared with transosseous sutures. Common failure mode was pull-out of the eyelet within the suture anchor in the HA group and rupture of the suture in the TA and TS group.
Conclusion Quadriceps tendon repair with suture anchors yields signicantly better biomechanical results than the commonly applied transosseous sutures in this human cadaveric study. These biomechanical ndings may change the future clinical treatment for quadriceps tendon ruptures. Randomised controlled clinical trials are desirable for the future.
Level of evidence Not applicable, controlled laboratory human cadaveric study.
Keywords Quadriceps tendon repair Suture anchors
Transpatellar tunnels Transosseous sutures
Biomechanics
Introduction
Incidences of ruptures of tendons and ligaments are reported as 166,6/100,000 per year for males and 52,1/ 100,000 per year for females [6]. Ruptures of the quadriceps tendon usually occur based on degenerative changes [21] caused by e.g. reduced blood supply, repetitive...