Comparing clinical outcomes between transosseous patellar suture fixation versus suture anchor repair in the treatment of quadriceps tendon rupture

Background: The standard surgical treatment of quadriceps tendon ruptures remains transosseous suture (TS) repair through the patella. Literature on suture anchor (SA) repair techniques is limited to biomechanical studies and small case series. SA offers superior biomechanical properties while maintaining a less-invasive approach to the patella and surrounding soft tissue. The objective of this study was to compare outcomes and complications of quadriceps tendon ruptures repaired with TS versus SA. Methods: A retrospective review of patients undergoing surgical repair of quadriceps tendon injuries between 2007 and 2018 was performed. Patients treated with TS repair or SA repair were identified. Clinical outcomes and complications were identified in the electronic medical record. Chi-squared, Fisher's exact, and independent sample t-tests were used to compare SA and TS groups. Results: This study included 154 quadriceps tendon ruptures in 143 patients: 128 males and 15 females with a mean age of 58.4 years. There were 41 injuries treated with SA repair and 113 injuries treated with TS repair. The average follow-up for the SA and TS groups was 8.0 and 7.9 months, respectively. Extension lag (3.3° vs 1.7°, p = 0.17) and terminal flexion (121° vs 116°, p = 0.29) were not statistically different between the SA and TS groups. Graded strength testing between SA and TS groups (4.4 vs 4.6, p = 0.03) was functionally comparable. There were no differences in complication rates. Conclusion: SA repair of quadriceps tendon ruptures provided similar clinical results compared to the gold standard TS repair. Range of motion and strength in this short-term follow-up study were comparable between groups with no difference in complication rates.