Transosseous Repair With Nice Knot Augmentation Versus Knotless Suture Anchor Repair With Suture Tape for Quadriceps Tendon Rupturer A Cadaveric Study

Quadriceps tendon rupture is typically repaired using either transosseous tunnels or suture anchors. Recent literature has suggested that suture an- chor repair is biomechanically superior to the use of transosseous tunnels. Augmentation of the transosseous technique with Nice knots may result in improved biomechanical properties as compared with a suture anchor construct. To compare biomechanical properties of a novel transosseous quadriceps tendon repair technique with Nice knot augmentation to those of knotless suture anchor repair, an artificial quadriceps tendon rupture was created in 10 matched pairs of cadaveric knees (n=20). Each cadaver was subjected to biomechanical testing to calculate the average ultimate load to failure, repair site gapping after early and late cyclic loading, and stiffness. Transosseous repair augmented with Nice knots as compared with knotless suture anchor repair had greater load to failure (mean +/- SD, 1489.5 +/- 297.6 N vs 717.7 +/- 191.4 N, P<.001), decreased gapping after early and late cyclic loading (cycles 1-20: mean +/- SD, 0.59 +/- 0.4 mm vs 2.1 +/- 1.2 mm, P=.008; cycles 21-250: mean +/- SD, 1.2 +/- 0.7 mm vs 3.9 +/- 1.7 mm, P=.002), and greater con- struct stiffness (mean +/- SD, 80.7 +/- 15.7 N/mm vs 44.4 +/- 13.4 N/mm, P=.001). The transosseous quadriceps tendon repair technique with Nice knot aug- mentation is biomechanically better than knotless suture anchor repair with regard to ultimate load to failure, gap formation after cyclic loading, and con- struct stiffness in cadaveric specimens.