What did the study look at?
Rupture of the patellar tendon (the tendon below the kneecap) is a serious injury that disables the mechanism that straightens the knee and can lead to loss of the ability to walk. The authors define tears older than 2 weeks as chronic and note that they are more complex to manage than acute tears. Over time the torn ends retract, tendon quality deteriorates and surrounding tissues scar, so direct repair is often not possible.
The aim of this article is to present a surgical technique for chronic patellar tendon ruptures using double-row suture anchor fixation reinforced with an Achilles tendon allograft (tissue from a donor).
How was it done?
This is a surgical technique article, not a study measuring outcomes in a group of patients. The technique is described for chronic cases in which the tendon has pulled off the bony bump at the top of the shin (tibial tubercle) or torn close to its attachment.
- Under general anaesthesia, the tendon is reached through a midline incision at the front of the knee.
- The tendon attachment site is cleaned down to healthy, bleeding bone.
- A central anchor and two knotless soft anchors on either side form the first row; the tendon is brought back into place and pressed onto the bone with sutures.
- A second anchor placed about 3 cm lower completes the second row.
- If the tendon tissue is poor, the repair is reinforced with an Achilles allograft cut to cover the whole tendon, and the side supporting tissues (retinaculum) are also repaired.
The article also describes the post-operative programme: for the first 2 weeks patients walk with crutches, bearing weight as tolerated, in a brace locked straight; knee bending targets are 0-30° at 2 weeks, 0-60° at 4 weeks and 0-90° at 6 weeks. The authors state that by 6 months patients are expected to walk normally without aids.
What did it find?
As a technique article, it reports no patient outcomes. The potential advantages listed by the authors are:
- A theoretically stronger construct than single-row fixation.
- Compression of the tendon onto a wider area of bone to support healing.
- No bone tunnels through the kneecap, avoiding the risk of fracture or penetration of the joint surface.
- No need to harvest the patient's own tendon.
- Early mobilisation, helping to prevent muscle wasting and knee stiffness.
The authors' conclusion
The authors argue that double-row fixation allows a chronic injury to be repaired directly without the need for a reconstruction, and that Achilles allograft reinforcement adds strength to the whole construct. They stress that clinical studies are needed to compare this technique with previously reported techniques.
Limitations
- The technique is more demanding than single-row fixation, particularly for surgeons who do not routinely perform double-row fixation.
- Operating time is longer, which may increase the risk of complications such as blood loss or infection.
- Costs are higher because of the additional anchors and allograft.
- It should not be used for tears further up the tendon or with significant tissue loss.
Reference
Cregar W, Fortier LM, Kerzner B, Dasari SP, Gürsoy S, Chahla J. Double-Row Suture Anchor Fixation and Achilles Allograft Augmentation for Chronic Patellar Tendon Rupture Repair. Arthroscopy Techniques. 2022;11(4):e631-e638. Licence: CC BY-NC-ND 4.0.
DOI: 10.1016/j.eats.2021.12.017
Free full text: PubMed Central (PMC9051965)
This article summarises a published scientific paper for general information; it does not replace an examination or a personal medical assessment. Please consult your doctor about your symptoms.
