Acute Patellar Tendon Rupture Repairs: What's the best surgical technique - Transosseous Tunnels or Suture Anchors?

Abstract

The patellar tendon (also referred to as patellar ligament in some published articles, since it connects bone to bone) is part of the extensor mechanism of the knee. It is a strong fibrous structure that connects the distal two thirds of the anterior surface of the patella to the tibial tuberosity. Acute patellar tendon ruptures (APTR) are rare injuries, commonly associated with falls in the ages of 20 - 30 years old. Patients often describe excruciating pain, alongside the impossibility of extending the knee.

To treat them, surgery is recommended and there are two main surgery techniques: transosseous tunnels (TT) or suture anchors (SA), a more recent method. This review of the literature aims to compare the two techniques, regarding different outcomes (such as biomechanical and post operation complications) and reach a scientifically valid conclusion.

With this objective in mind, an exhaustive search was conducted by the authors, using scientific database as PubMed and Web of Science, as well as orthopedic surgery books, focusing exclusively on peer-reviewed research articles that specifically compare the Transosseous Tunnels and Suture Anchors techniques in the repair of acute patellar tendon ruptures.

The use of transpatellar tunnels remains the gold standard in acute patellar tendon rupture surgical repair. Nevertheless, studies have shown that the use of suture anchors has less gap formation, increased load to failure and less complications, such as retear or need to reoperate. The cost of SA is greater than TT and, therefore, this can be a setback for its implementation.