VanDerwerker Nicholas B, Winzenried Alec E, Mosiman Samuel J, Grogan Brian F, Baer Geoffrey S, Cotter Eric J
Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A.
Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A..
Arthroscopy. 2025 May 27. doi: 10.1016/j.arthro.2025.04.059.
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).
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.
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).
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 IV, systematic review of Level III and IV studies.
比较经骨隧道（TO）技术与缝线锚钉（SA）技术对单侧股四头肌肌腱断裂（QTR）进行初次修复的临床效果。
对PubMed数据库进行系统回顾，纳入使用TO和/或SA技术对原发性QTR修复的再断裂和/或患者报告结局指标（PROM）结局数据的研究。使用非随机研究方法学指数评分系统对纳入研究进行评估。
12项研究共600例患者符合系统回顾的纳入标准。这些研究的证据水平为III至IV级，大多数（n = 10；83.3%）为回顾性病例系列。在纳入研究中，TO修复占患者的79.5%（n = 477），而20.5%（n = 123）采用SA修复。所有使用SA的出版物均报告在原发性QTR修复中放置2至3个锚钉。报告使用TO方法的研究大多钻3个髌骨孔，尽管1项研究仅钻2个孔，2项研究钻3至4个孔，3项研究未报告此信息。TO技术的QTR再断裂率在0%至16.7%之间，SA技术在0%至14.7%之间。PROM收集差异很大，仅有有限数据能明确显示TO或SA技术的优越性。非对比研究的方法学质量中等，平均评分为10.2±1.3（范围8 - 12），对比研究的方法学质量中等，平均评分为15.7±2.1（范围14 - 18）。
对于原发性QTR修复，TO和SA修复方法的再断裂率相似。一些数据表明，基于PROM，SA技术在原发性QTR修复中可能比TO方法显示出更好的效果，但缺乏高质量证据。
IV级，III级和IV级研究的系统回顾。
