Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 23, Issue 4, pp 1039–1045 | Cite as

Suture anchor repair yields better biomechanical properties than transosseous sutures in ruptured quadriceps tendons

  • M. PetriEmail author
  • A. Dratzidis
  • S. Brand
  • T. Calliess
  • C. Hurschler
  • C. Krettek
  • M. Jagodzinski
  • M. Ettinger



This human cadaveric study compares the biomechanical properties of quadriceps tendon repair with suture anchors and the commonly applied transosseous sutures. The hypothesis was that suture anchors provide at least equal results concerning gap formation and ultimate failure load compared with transosseous suture repair.


Thirty human cadaveric knees underwent tenotomy followed by repair with either 5.5-mm-double-loaded suture anchors [titanium (TA) vs. resorbable hydroxyapatite (HA)] or transpatellar suture tunnels using No. 2 Ultrabraid™ and the Krackow whipstitch. Biomechanical analysis included pretensioning the constructs with 20 N for 30 s and then cyclic loading of 250 cycles between 20 and 100 N at 1 Hz in a servohydraulic testing machine with measurement of elongation. Ultimate failure load analysis and failure mode analysis were performed subsequently.


Tendon repairs with suture anchors yielded significantly less gap formation during cyclic loading (20th–250th cycle: TA 1.9 ± 0.1, HA 1.5 ± 0.5, TS 33.3 ± 1.9 mm, p < 0.05) and resisted significantly higher ultimate failure loads (TA 740 ± 204 N, HA 572 ± 67 N, TS 338 ± 60 N, p < 0.05) compared with transosseous sutures. Common failure mode was pull-out of the eyelet within the suture anchor in the HA group and rupture of the suture in the TA and TS group.


Quadriceps tendon repair with suture anchors yields significantly better biomechanical results than the commonly applied transosseous sutures in this human cadaveric study. These biomechanical findings may change the future clinical treatment for quadriceps tendon ruptures. Randomised controlled clinical trials are desirable for the future.

Level of evidence

Not applicable, controlled laboratory human cadaveric study.


Quadriceps tendon repair Suture anchors Transpatellar tunnels Transosseous sutures Biomechanics 



The authors thank Mr. Reinhold Krentscher from the Institute of Legal Medicine and Mr. Markus Badenhop from the Laboratory for Biomaterials and Biomechanics for their help and Dr. Fabian Goede for his excellent drawings in Figs. 1 and 2.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • M. Petri
    • 1
    Email author
  • A. Dratzidis
    • 1
  • S. Brand
    • 1
  • T. Calliess
    • 2
  • C. Hurschler
    • 3
  • C. Krettek
    • 1
  • M. Jagodzinski
    • 1
  • M. Ettinger
    • 2
  1. 1.Trauma DepartmentHannover Medical School (MHH)HannoverGermany
  2. 2.Orthopaedic Surgery DepartmentHannover Medical School (MHH)HannoverGermany
  3. 3.Laboratory for Biomaterials and Biomechanics (LBB), Orthopaedic Surgery DepartmentHannover Medical School (MHH)HannoverGermany

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