Suture Anchor Fixation Has Less Gap Formation And No Difference In Complications Or Revisions For Patellar Tendon Repair: A Systematic Review

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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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ePub ahead of print