Abstract
The objective of this study is to compare the cyclic loading strength and ultimate
failure load in suture anchor repair versus transosseous tunnel repair of patellar
tendons using a cadaver model. Twelve cadaveric patella specimens were used (six matched
pairs). Dual-energy X-ray absorptiometry (DXA) measurements were performed to ensure
equal bone quality among groups. All right knees were assigned to the suture anchor
repair group (n = 6), whereas all left knees were assigned to the transosseous bone tunnel group
(n = 6). Suture type and repair configuration were equivalent. After the respective
procedures were performed, each patella was mounted into a gripping jig. Tensile load
was applied at a rate of 1 Hz between magnitudes of 50 and 150 N, 50 and 200 N, 50
and 250 N, and tensile load at a rate of 0.1 mm/s until failure. Failure was defined
as a sharp deviation in the linear load versus displacement curve, and failure mode
was recorded. DXA measurements demonstrated equivalence of bone quality between the
two groups (p > 0.05). During cyclic load testing, there was only a statistically significant difference
between the groups with regard to cyclic loading at the 50 to 200 N loading cycle
(p = 0.010). There was no statistically significant difference between the groups with
regard to ultimate load to failure (p = 0.43). Failure mode within the suture anchor cohort occurred through anchor pullout
except for one, which failed through the tendon. All specimens within the transosseous
cohort failed through the midsubstance of the tendon except for one, which failed
through suture breakage. Suture anchor repair demonstrated a similar biomechanical
profile regarding cyclic loading and ultimate load to failure when compared with “gold
standard” transosseous tunnel patellar tendon repair with a trend toward less gapping
in the suture anchor group. Using suture anchors for repair of the patella tendon
has similar biomechanical properties to transpatellar tunnels but may provide other
clinical advantages.
Keywords
patella tendon rupture - suture anchor repair - transosseous tunnel repair - cyclic
loading strength - biomechanics
