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Cortical Button Fixation: A Better Patellar Tendon Repair?

Gabriella E Ode1, Dana P Piasecki2, Nahir A Habet3

  • 1Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, North Carolina, USA gabriellaode@gmail.com.

The American Journal of Sports Medicine
|July 9, 2016
PubMed
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Cortical button fixation for patellar tendon repair shows superior biomechanical performance compared to traditional suture and anchor methods. This novel technique offers less gap formation and higher load to failure, potentially improving patient recovery.

Area of Science:

  • Orthopedic surgery
  • Biomechanical engineering
  • Sports medicine

Background:

  • Patellar tendon ruptures necessitate surgical intervention for optimal outcomes.
  • Current surgical techniques lack a consensus on the ideal method for patellar tendon repair.
  • Cortical button fixation is a secure tendon repair method not previously studied for patellar tendons.

Purpose of the Study:

  • To evaluate the biomechanical performance of cortical button fixation for patellar tendon repair.
  • To compare cortical button repair against standard transpatellar suture repair and suture anchor repair.

Main Methods:

  • A controlled laboratory study utilized 23 fresh-frozen cadaveric knees with simulated patellar tendon ruptures.
  • Three repair techniques were compared: transpatellar suture, polyetheretherketone (PEEK) suture anchor, and cortical button fixation.
Keywords:
biomechanicskneepatellar tendontendon/ligament repair

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  • Specimens underwent cyclic quadriceps contraction testing to assess gap formation, load to failure, and failure modes.

    • Main Results:

    • Cortical button repair demonstrated significantly less gap formation under cyclic loading compared to both anchor and suture repairs.
    • Cortical button repair sustained significantly higher loads to failure than both anchor and suture repair methods.
    • Failure modes varied, with cortical button repairs showing unique failure patterns including subsidence through the patella.

    Conclusions:

    • Cortical button fixation offers significant mechanical advantages over traditional suture and anchor repairs for patellar tendons in cadaveric models.
    • The reduced cyclic gap formation and increased load to failure suggest potential clinical benefits for accelerated rehabilitation.