Clinical outcomes after treatment of quadriceps tendon ruptures show equal results independent of suture anchor or transosseus repair technique used – A pilot study

Abstract

Biomechanical studies have shown the use of suture anchors (SA) to be superior to the traditional transosseous sutures (TS) in the repair of quadriceps tendon rupture (QTR). This study aimed to analyze and compare the functional outcomes of patients treated for quadriceps tendon ruptures using suture anchors or transosseous sutures. Patients having undergone suture anchor repair or transosseous suture repair for quadriceps tendon rupture between 2010 and 2015 at one of the two participating hospitals were included. Patients from site A underwent TS repair (TS group) while patients from site B underwent SA repair (SA group). Exclusion criteria included previous or concomitant injuries of the involved knee, penetrating injuries and pre-existing neurological conditions. Clinical outcome was assessed by subjective scores (Lysholm and Tegner Scores, International Knee Documentation Committee (IKDC) Score, Visual Analog Scale (VAS) for pain), quadriceps isokinetic strength testing, Insall-Salvati Index (ISI), and physical examination. Non-parametrical statistical analysis was conducted using the Mann-Whitney U test. Twenty-seven patients were included in the study of which 17 patients (63%) were available for follow-up (SA group: 9, TS group: 8). All patients were male with a mean age of 62.7 (SD: 8.8) and 57.9 (SD: 12.7) years for the SA group and TS group, respectively. The groups did not differ in terms of demographic characteristics. No clinically significant differences were identified between the two groups. There were no re-ruptures in either group. Treatment of quadriceps tendon rupture using suture anchors provides a clinically valid alternative treatment to the gold-standard transosseous suture repair.

Isokinetic Evaluation of Knee Strength and Endurance in Hemodialysis Patients Treated with the Transpatellar Tunnel Technique for Bilateral Spontaneous Quadriceps Tendon Ruptures

“…There are many previous studies addressing quadriceps tendon strength following tendon repair. 8,[17][18][19] In these studies, there was no significant difference between the affected and unaffected limbs in which isokinetic measurements were used to assess the muscle strength following the repair. To the best of our knowledge, this is the first study which directly compared the strength of the quadriceps tendon, with isokinetic tests, between hemodialysis patients treated with the transpatellar tunnel technique for bilateral spontaneous quadriceps tendon ruptures and hemodialysis patients without a history of rupture.…”

“…Plesser et al reported that the mean ROM of all operated legs was 132 degrees in the suture anchor group and 138 degrees (120-150 degrees) in the transosseous group. 18 Puranik and Faraj reported 21 cases with quadriceps tendon rupture treated with the transosseous technique and found that the mean active ROM of the affected limb was 0.5 to 102.5 (0-110 being the normal range). 21 In our study, we found an active ROM 113.7 AE 9.7 degrees (range, 90-130 degrees) in the operated group, and the control group was 130 AE 4.8 degrees.…”

“…Isokinetic evaluation of the knee after repair of quadriceps tendon rupture has been conducted in many studies that evaluate the strength of the quadriceps, comparing the healthy and the affected leg to determine the presence of any deficits. 8,[17][18][19]22 Plesser et al reported the result of quadriceps strength using the PT/BW of the operated leg or the mean PT/BW of both knees in bilateral injuries. 18 In their study, the statistical analysis of mean PT/BW at 60degrees/s identified no significant differences between the two groups.…”

“…8,[17][18][19]22 Plesser et al reported the result of quadriceps strength using the PT/BW of the operated leg or the mean PT/BW of both knees in bilateral injuries. 18 In their study, the statistical analysis of mean PT/BW at 60degrees/s identified no significant differences between the two groups. Another study by Konrath et al 8 showed that more than half of their unilateral quadriceps tendon rupture patients had significant (>20%) quadriceps strength deficits at 60 degrees/s at a mean follow-up of 4 years.…”

Polyethylene terephthalate tape augmentation as a solution in recurrent quadriceps tendon ruptures

“…Standard techniques used to repair QMF tendon rupture have some disadvantages 8,9 ; they lack sufficient strength to permit patients to exercise the full range of motion. There is no consensus regarding rehabilitation protocol.…”