Retensionable All-Suture Anchor Extensor Mechanism Repair

Extensor mechanism tendon ruptures, including the quadriceps and patellar tendons, are devastating injuries that most often require acute surgical repair to restore knee mechanics and function. There are 2 well-described categories of quadriceps repair techniques, including superior pole suture anchor repairs and transosseous repairs, with recent studies reporting similar overall outcomes. However, failure rates have been reported to be as high as 18% and 21%, respectively.

Extensor mechanism ruptures.

The described technique utilizes 2 transosseous patellar tunnels. Retensionable all-suture anchor loops are then passed from the distal cortex to the near cortex, setting the suture anchors at the distal cortex. A Krakow stitch is passed from proximal to distal along the medial tendon, through the suture loop, and then distal to proximal through the central tendon and tied. This is repeated for the lateral half of the tendon. The suture loops are then tensioned to reduce the quadriceps tendon to the patella. The knee is cycled to remove creep from the Krakow suture, and the anchors are retensioned as needed to avoid gapping. This technique can also be utilized for patellar tendon ruptures in a similar fashion, with passage of the loops from proximal to distal and setting of the all-suture implant at the superior pole.

In our experience, patients undergoing extensor mechanism repair with knotless retensionable all-suture anchors have achieved successful outcomes. The transosseous adjustable all-suture anchor has been shown to be biomechanically superior to a traditional transosseous suture repair, with significantly less gap formation, higher load-to-failure, and greater stiffness. Furthermore, the adjustable knotless anchor allows retensioning that may improve compression, minimize laxity both intra- and postoperatively, and allow more aggressive flexion range of motion during the early postoperative course. The all-suture anchor may also potentially limit complications related to hardware irritation when metal buttons are used for bicortical fixation or hard-bodied anchors are utilized at the superior pole.

Transosseous retensionable all-suture anchors offer an alternative high- strength construct for extensor mechanism repairs, with a unique ability to minimize creep within repair constructs intraoperatively.

The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.