A Method of Repair for Quadriceps Tendon or Patellar Ligament (Tendon) Ruptures Without Cast Immobilization

Levy, Michael J.; Goldstein, Jed; Rosner, Michael

doi:10.1097/00003086-198705000-00040

Cited by 78 publications

(61 citation statements)

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“…However, we recognize that switching to a new technique comes with a learning curve and comfort factor. We believe this augmentation method is simpler than other previously described techniques [13,15,16,23,25,30,36] and does not require additional exposure or instrumentation. As with many new techniques, an initial attempt with the technique in a cadaver laboratory setting could prove beneficial but we believe the technique can be incorporated easily in clinical practice.…”

Section: Discussionmentioning

confidence: 91%

“…Prompt surgical repair of patellar tendon ruptures is preferred in patients fit for surgery to restore the extensor mechanism and allow optimal return to function [22,28,37], but studies disagree about the best surgical technique [7,11,15,[25][26][27][28]. Despite routine use of the transosseous tunnel and modified-Krackow suture technique, little is known about the biomechanical properties of this repair method.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the numerous small retrospective series on repair techniques with and without augmentation [1,6,11,13,15,16,23,25,26,28,30,33,36,40], the biomechanical evidence is limited. In 2002, Ravalin et al [35] were the first to describe systematic testing of the efficacy of suture and cable augmentation using a biomechanical model.…”

Section: Discussionmentioning

confidence: 99%

“…Rupture of the patellar tendon is a potentially disabling injury typically often treated with surgical repair [11,20,[25][26][27][28]37]. Successful repair can prove challenging owing to the high mechanical loads across the repair and the impaired healing potential of tendons because of their relatively poor blood supply.…”

Section: Introductionmentioning

confidence: 99%

“…The feared complication of catastrophic repair failure historically has led many surgeons to recommended a period of postoperative knee immobilization in extension to decrease the strain across the repair [13,20,22,30,33,37]; however, the benefits of early motion have been shown to include adhesion reduction, improved knee motion, and promotion of tendon healing with earlier remodeling of collagen fibers and increased collagen filaments crosslinking and strength [8-10, 21, 24, 31, 38]. As a result, several augmentation techniques have been described to allow for earlier motion and full weightbearing and perhaps decreasing the risk of failure [1,6,13,15,16,23,25,26,28,30,33,36,40]. Many of the proposed augmentation techniques have required a second operation for removal of the hardware or synthetic material used in the augmentation [6,15,26,36].…”

Section: Introductionmentioning

confidence: 99%

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Novel Augmentation Technique for Patellar Tendon Repair Improves Strength and Decreases Gap Formation: A Cadaveric Study

Black

Ricci

Gardner

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Patellar tendon ruptures commonly are repaired using transosseous patellar drill tunnels with modified-Krackow sutures in the patellar tendon. This simple suture technique has been associated with failure rates and poor clinical outcomes in a modest proportion of patients. Failure of this repair technique can result from gap formation during loading or a single catastrophic event. Several augmentation techniques have been described to improve the integrity of the repair, but standardized biomechanical evaluation of repair strength among different techniques is lacking. Questions/purposes The purpose of this study was to describe a novel figure-of-eight suture technique to augment traditional fixation and evaluate its biomechanical performance. We hypothesized that the augmentation technique would (1) reduce gap formation during cyclic loading and (2) increase the maximum load to failure. Methods Ten pairs (two male, eight female) of freshfrozen cadaveric knees free of overt disorders or patellar tendon damage were used (average donor age, 76 years; range, 65-87 years). For each pair, one specimen underwent the standard transosseous tunnel suture repair with a modified-Krackow suture technique and the second underwent the standard repair with our experimental augmentation method. Nine pairs were suitable for testing. Each specimen underwent cyclic loading while continuously measuring gap formation across the repair. At the completion of cyclic loading, load to failure testing was performed. Results A difference in gap formation and mean load to failure was seen in favor of the augmentation technique. At 250 cycles, a 68% increase in gap formation was seen for the control group (control: 5.96 ± 0.86 mm [95% CI, 5.30-6.62 mm]; augmentation: 3.55 ± 0.56 mm [95% CI, 3.12-3.98 mm]; p = 0.02). The mean load to failure was 13% greater in the augmentation group (control: 899.57 ± 96.94 N [95% CI, 825.06-974.09 N]; augmentation: 1030 augmentation: .70 ± 122.41 N [95% CI, 936.61-1124; p = 0.01). Conclusions This biomechanical study showed improved performance of a novel augmentation technique compared with the standard repair, in terms of reduced gap formation during cyclic loading and increased maximum load to failure. Clinical Relevance Decreased gap formation and higher load to failure may improve healing potential and minimize failure risk. This study shows a potential biomechanical advantage of the augmentation technique, providing support for future clinical investigations comparing this

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Novel Augmentation Technique for Patellar Tendon Repair Improves Strength and Decreases Gap Formation: A Cadaveric Study

Black

Ricci

Gardner

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Delayed surgical repair of a rupture of quadriceps tendons in a dog after failure of primary surgery

Vlasin,

Lewis,

Mala

et al. 2024

Vet Record Case Reports

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A 10‐month‐old female American bulldog presented for surgical revision of a left quadriceps injury that was sustained after running into a glass table. The wounds were initially repaired and tendons reattached at the referring practice. However, the dog remained non‐weight bearing following the initial surgery. A substantial gap could be palpated within the quadriceps, proximal to the stifle joint, indicating failure of the quadriceps mechanism repair. Radiography of the limb revealed a large joint effusion and soft tissue swelling around the stifle. Surgical revision of the quadriceps deficit was performed. The dog made a full recovery and no residual lameness was evident 6 months following surgery.

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Patellar Tendinopathy and Patellar Tendon Rupture

Khan¹,

Cook²,

Maffulli³

Tendon Injuries

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A Method of Repair for Quadriceps Tendon or Patellar Ligament (Tendon) Ruptures Without Cast Immobilization

Cited by 78 publications

References 0 publications

Novel Augmentation Technique for Patellar Tendon Repair Improves Strength and Decreases Gap Formation: A Cadaveric Study

Novel Augmentation Technique for Patellar Tendon Repair Improves Strength and Decreases Gap Formation: A Cadaveric Study

Delayed surgical repair of a rupture of quadriceps tendons in a dog after failure of primary surgery

Patellar Tendinopathy and Patellar Tendon Rupture

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