Wittstein Jocelyn R, Tejada Marcos D, Smith Benjamin L, Werner Brian C, Frank Rachel M, Hauck Oliver L, Wijdicks Coen A
Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA.
Department of Research, Arthrex, Inc, Naples, Florida, USA.
Orthop J Sports Med. 2025 Aug 14;13(8):23259671251356627. doi: 10.1177/23259671251356627. eCollection 2025 Aug.
Reruptures and functional deficits can occur with conventional transosseous quadriceps tendon repair. Previous work has demonstrated the biomechanical superiority of adjustable transosseous metal cortical button fixation over conventional repair. Knotless all-suture anchor (ASA) buttons may provide a similar improvement but have not yet been investigated.
To biomechanically compare adjustable transosseous cortical fixation with knotless ASAs to traditional transosseous repair.
Controlled laboratory study.
Eight matched pairs of male cadaveric knees were dissected to isolate and release the quadriceps tendon insertion. Paired knees were randomized to 2.6-mm knotless ASA or control repair, both with Krackow suturing using 1.7-mm suture tape. The ASA technique had two 1.6-mm tunnels through which the knotless ASA loops interlocked with the Krackow sutures. The control technique had three 2.4-mm tunnels through which suture tape tails were passed and tied over bone bridges. Knees were mounted onto a materials testing system and actuated from 5° to 90° of flexion via the quadriceps tendon for 10 native preconditioning cycles and 250 cycles after repair 0.1 Hz, with a peak force of 150 N per cycle. Repairs were loaded to failure at a rate of 50 mm/min. Outcomes included plastic gap formation (mm) during cyclic loading and stiffness (N/mm), yield load (N), and ultimate load (N) during load to failure. Paired tests were used for statistical analysis ( < .05).
The ASA had significantly less gap formation at cycle 250 (mean Δ = 6.3 mm; < .001) and superior stiffness (Δ = 17.7 N/mm; = .004), yield load (Δ = 40 N; = .014), and ultimate load (Δ = 127 N; = .015) compared with the control. The mean transosseous control displacement surpassed the defined critical threshold for gap formation (5.0 mm) in this study by cycle 50, whereas the mean ASA displacement never did.
Compared with conventional transosseous quadriceps tendon repair, adjustable ASA transosseous repair had 64% less tendon-bone gap formation, 35% greater stiffness, 21% greater yield load, and 27% greater ultimate load.
Adjustable knotless ASA cortical fixation is a viable alternative for transosseous quadriceps tendon repair that increases repair strength and reduces patellar tunnel drilling.
传统的经骨四头肌腱修复可能会出现再断裂和功能缺陷。先前的研究表明，可调节经骨金属皮质纽扣固定在生物力学上优于传统修复方法。无结全缝线锚钉（ASA）纽扣可能也能提供类似的改善效果，但尚未得到研究。
对可调节经骨皮质固定与无结ASA纽扣固定和传统经骨修复进行生物力学比较。
对照实验室研究。
解剖8对匹配的男性尸体膝关节，以分离并松解四头肌腱附着点。将配对的膝关节随机分为接受2.6毫米无结ASA修复或对照修复，两者均采用1.7毫米缝线带进行Krackow缝合。ASA技术有两个1.6毫米的隧道，无结ASA环通过这些隧道与Krackow缝线互锁。对照技术有三个2.4毫米的隧道，缝线带尾端穿过这些隧道并在骨桥上打结。将膝关节安装在材料测试系统上，通过四头肌腱从5°屈曲至90°，进行10次原位预适应循环以及修复后以0.1赫兹频率进行250次循环，每个循环的峰值力为150牛。修复处以50毫米/分钟的速率加载至失效。结果包括循环加载期间的塑性间隙形成（毫米）以及加载至失效期间的刚度（牛/毫米）、屈服载荷（牛）和极限载荷（牛）。采用配对t检验进行统计分析（P < .05）。
与对照组相比，ASA在第250个循环时的间隙形成明显更少（平均Δ = 6.3毫米；P < .001），并且具有更好的刚度（Δ = 17.7牛/毫米；P = .004）、屈服载荷（Δ = 40牛；P = .014）和极限载荷（Δ = 127牛；P = .015）。在本研究中，对照组经骨平均位移在第50个循环时超过了定义的间隙形成临界阈值（5.0毫米），而ASA的平均位移从未超过。
与传统经骨四头肌腱修复相比，可调节ASA经骨修复的肌腱 - 骨间隙形成减少64%，刚度提高35%，屈服载荷提高21%，极限载荷提高27%。
可调节无结ASA皮质固定是经骨四头肌腱修复的一种可行替代方法，可提高修复强度并减少髌隧道钻孔。
