Transosseous Tunnel Suture Fixation Results in Similar Rerupture Rates and Patient-Reported Outcome Measures Compared to Suture Anchors for Primary Quadriceps Tendon Repair: A Systematic Review.

PURPOSE: To compare the clinical outcomes of transosseous tunnel (TO) techniques to suture anchor (SA) techniques for the primary repair of unilateral quadriceps tendon ruptures (QTRs).

METHODS

A systematic review of the PubMed database was performed for studies containing rerupture and/or patient-reported outcome measure (PROM) outcome data of primary QTR repairs utilizing TO and/or SA techniques. Included studies were evaluated using the Methodological Index for Nonrandomized Studies scoring system.

RESULTS

Twelve studies including 600 patients met inclusion criteria for the systematic review. The level of evidence for these studies ranged from III to IV, with most (n = 10; 83.3%) being retrospective case series. Within included studies, TO repairs accounted for 79.5% of patients (n = 477), while 20.5% (n = 123) underwent repair using SA. All publications using SAs reported placing 2 to 3 anchors for the primary QTR repair. Studies reporting using TO methods mostly placed 3 patellar drill holes, although 1 study only used 2 drill holes, 2 studies used 3 to 4 drill holes, and 3 studies did not report this information. QTR rerupture rates varied between 0% and 16.7% for TO techniques and between 0% and 14.7% for SA techniques. PROM collection varied widely, with limited data to clearly show the superiority of TO or SA techniques. The methodologic quality for noncomparative studies was moderate, with a mean score of 10.2 ± 1.3 (range, 8-12), and was moderate for comparative studies, with a mean score of 15.7 ± 2.1 (range, 14-18).

CONCLUSIONS

Rerupture rates were similar between TO and SA repair methods for primary QTR repairs. Some data indicate that SA techniques might show superior outcomes based on PROMs between SA and TO methods for the primary repair of QTRs, but high-quality evidence is lacking.

LEVEL OF EVIDENCE: Level IV, systematic review of Level III and IV studies.