Lower Satisfaction and Inferior Outcomes Associated With Delayed Surgery for Chronic Quadriceps Tendon Ruptures: A Systematic Review.

PURPOSE: To evaluate the literature regarding the efficacy of various repair and reconstruction surgical techniques for chronic quadriceps tendon ruptures (QTRs) in native knees and to assess their associated outcomes.

METHODS

A comprehensive literature search of the EMBASE, PubMed/MEDLINE, and Cochrane databases was conducted from October 2023 to November 2024 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Clinical studies that analyzed outcomes following surgical intervention of chronic QTRs with Level IV or greater evidence were included. We excluded case reports and QTRs in the setting of total knee arthroplasty. Quality assessment was conducted using Methodological Index for Non-Randomized Studies criteria.

RESULTS

Ten studies published between 1981 and 2022 were included. Described techniques included direct tendon repair, lengthening procedures, and various graft and mesh augmentations. Reported failure rates ranged from 0 to 33%. Extensor lag remained a common reported complication (5 of 10 studies).

CONCLUSIONS

The current body of literature on the surgical management of chronic QTRs is characterized by significant heterogeneity in surgical technique and a predominantly low quality of evidence. The various surgical techniques described suffer from limited follow-up and inconsistently reported outcome measures.

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