Abstract
Purpose
The purpose of this systematic review was to evaluate the literature on suture anchor
usage for patellar tendon repair, summarize the overall biomechanical and clinical
outcomes, and assess whether the cumulative research supports the adoption of this
technique compared to trans-osseous repair.
Methods
A systematic literature review using the Preferred Reporting Items for Systematic
and Meta-Analyses (PRISMA) guidelines was performed. Multiple electronic databases
were searched to identify studies focusing on surgical outcomes of patellar tendon
repair with suture anchor usage. Cadaver and animal biomechanical studies, technical studies, and clinical studies
were included.
Results
A total of 29 studies met the inclusion criteria: 6 cadaver, 3 animal, 9 technical,
and 11 clinical reports. Four of the 6 cadaver studies and one of the two animal studies
found significantly less gap formation from suture anchor (SA) than from trans-osseous
(TO) repair. Average gap formation in human studies ranged from 0.9-4.1mm in the SA
group compared to 2.9-10.3mm in TO groups. Load to failure was significantly stronger
in one of five cadaver studies and two of three animal studies, with human studies
suture anchor load to failure ranging from 258-868N and trans-osseous load to failure
ranging from 287-763N. There were 11 clinical studies that included 133 knees repaired
using SA. Nine studies showed no difference between complication rate or risk for
reoperation, where one study reported a significantly lower re-rupture rate after
SA repair compared to trans-osseous repair.
Conclusion
SA repair is a viable option for patellar tendon repair and could have several advantages
over trans-osseous repair. Multiple studies indicate that SA repair has less gap formation
during biomechanical testing compared to trans-osseous repair in human cadaver and
animal models. No differences in complications or revisions were found in the majority
of clinical studies.
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Article info
Publication history
Accepted:
May 11,
2023
Received in revised form:
May 10,
2023
Received:
December 10,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Clinical Relevance: Both animal and human models suggest suture anchor fixation has potential biomechanical benefits when compared to trans-osseous tunnels for patellar tendon repair, while clinical studies show no difference in complications and revisions postoperatively.
Figure 1: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Diagram
Identification
Copyright
© 2023 Published by Elsevier on behalf of the Arthroscopy Association of North America
