Suture anchors versus transosseous tunnels for acute patellar tendon rupture: A retrospective comparative cohort study.

BACKGROUND

Whether suture anchors (SA) offer meaningful advantages over transosseous tunnels (TT) for primary repair of acute patellar tendon rupture remains uncertain.

METHODS

Single-center retrospective cohort (January 2014-December 2022) of adults with acute patellar tendon rupture treated with SA or TT in two consecutive cohorts, non-overlapping temporal cohorts. Primary outcome was overall recorded operative time (no phase-specific timings); secondary outcomes were pain (VAS), range of motion (ROM), return to sport/work, Lysholm, EQ-5D VAS, EQ-5D index, and complications/reoperation. Multivariable models adjusted for age, sex, BMI, corticosteroid therapy, smoking, diabetes, chronic kidney disease, and technique (two-sided p<0.05). No peri-tendinous augmentation was performed.

RESULTS

Of 55 screened cases, 46 met criteria (SA n=25; TT n=21). Mean follow-up was 5.1±3.7 years (SA 5.16±3.48 vs TT 5.00±3.22; p=0.760). Unadjusted operative time was lower with SA (78.7±21.2 vs 99.6±30.1min; p=0.085). In multivariable linear regression, SA was associated with an adjusted -20.0-min difference (95% CI -35.2 to -4.8; p=0.012). This association reached statistical significance after covariate adjustment. No adjusted between-group differences were detected for pain, ROM, return to sport/work, Lysholm, EQ-5D VAS, or EQ-5D index. Complications were similar (adjusted OR 1.15; 95% CI 0.68-1.95; p=0.45).

CONCLUSIONS

Suture anchors were associated with shorter overall recorded operative time than transosseous tunnels, with no detectable differences in clinical outcomes or complications. Both constructs appear reliable with standardized rehabilitation; findings are hypothesis-generating given nonrandomized temporal allocation and unmeasured intra-operative determinants.

LEVEL OF EVIDENCE: IV (retrospective cohort).