Background:

Transosseous tunnel (TO) repair is considered the gold standard for patellar tendon rupture; however, suture anchor (SA) repair has emerged as a viable alternative in recent years. Although both these techniques are used widely in clinical practice, the most biomechanically optimal construct for patellar tendon repair remains unknown.

Purpose:

To examine published studies on the biomechanical properties of TO and SA fixation for patellar tendon repair in terms of ultimate load to failure and cyclic gap formation. The null hypothesis was that there would be no significant difference in either outcome measure between the groups.

Study Design:

Systematic review.

Methods:

A systematic review using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed by searching PubMed, the Cochrane Library, and Embase to identify studies that analyzed the biomechanical properties of SA and TO techniques for repair of a ruptured patellar tendon. The search phrase implemented was “patellar tendon repair.” Meta-analysis was performed to provide a quantitative comparison of the 2 techniques with regard to ultimate load to failure and cyclic gap displacement. Weighted averages were calculated for all quantitative outcomes, and outcomes were summarized in a forest plot. A random-effects model was used to account for the heterogeneity among the included studies in the final statistical analysis.

Results:

Of 875 studies initially screened, the inclusion criteria were met by 7 studies, including 128 cadaveric specimens (66 SA, 62 TO). The pooled analysis from 6 studies reporting on gap displacement revealed a statistically significant difference in favor of SA versus TO fixation (P < .001). Pooled analysis from 7 studies reporting on ultimate load to failure did not reveal a statistically significant difference between the use of SA and TO for tendon repair (P = .465).

Conclusion:

Our systematic review revealed that the use of SA fixation for patellar tendon repair was associated with lower cyclic gap displacement when compared with TO fixation. There was no significant difference in ultimate load to failure between the repair techniques.

中文翻译：

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髌腱修复缝合锚固定与经骨隧道技术的失败率：生物力学研究的系统评价和荟萃分析

背景：

经骨隧道（TO）修复被认为是髌腱断裂的金标准；然而，近年来，缝合锚钉 (SA) 修复已成为一种可行的替代方案。尽管这两种技术都在临床实践中广泛使用，但最适合髌腱修复的生物力学优化构造仍然未知。

目的：

研究已发表的关于 TO 和 SA 固定用于髌腱修复的生物力学特性的研究，即失效的极限载荷和循环间隙形成。零假设是两组之间的任一结果测量都没有显着差异。

学习规划：

系统评价。

方法：

通过搜索 PubMed、Cochrane 图书馆和 Embase，使用 PRISMA（系统评价和 Meta 分析的首选报告项目）指南进行系统评价，以确定分析 SA 和 TO 技术的生物力学特性以修复破裂的髌腱的研究. 实施的搜索短语是“髌腱修复”。进行了荟萃分析，以提供两种技术在极限载荷失效和循环间隙位移方面的定量比较。计算所有定量结果的加权平均值，并将结果汇​​总在森林图中。在最终统计分析中，使用随机效应模型来解释纳入研究之间的异质性。

结果：

在最初筛选的 875 项研究中，7 项研究符合纳入标准，包括 128 份尸体标本（66 SA，62 TO）。来自 6 项报告间隙位移的研究的汇总分析显示，SA 与 TO 固定存在统计学显着差异（P < .001）。来自 7 项报告关于失效极限载荷的研究的汇总分析未显示使用 SA 和 TO 进行肌腱修复之间的统计学显着差异 ( P = .465)。

结论：

我们的系统评价显示，与 TO 固定相比，使用 SA 固定进行髌腱修复与较低的周期性间隙位移有关。修复技术之间的失效极限载荷没有显着差异。