High-Strength Suture Tape Augmentation Improves Cyclic Gap Formation in Transosseous Patellar Tendon Repair: A Biomechanical Study.

Purpose: To compare gap displacement at various intervals of cyclic testing and biomechanical load to failure of a Krackow patellar tendon repair augmented with high-strength suture tape versus the standard Krackow transosseous technique for inferior pole patellar tendon rupture.

Methods: Twelve matched pairs of cadaveric knees were used (8 males and 4 females; mean age 79.6 years, range 57 to 96). An inferior pole patellar tendon rupture was simulated after random assignment of specimens in each pair to the standard or augmented Krackow technique. Each specimen was then repetitively cycled from 90° to 5° for 1,000 cycles. A differential variable reluctance transducer was used to measure gap displacement. After cyclic loading, load to failure was determined by pulling the tendon at a rate of 15 mm/s until a sudden decrease in load occurred.

Results: Compared with the control repair, specimens with augmented repair demonstrated significantly less displacement at all testing intervals up to 1,000 cycles ( < .05). Two patellar tendons failed before the end of cyclic loading, and 4 specimens had inadequate tendon length for loading. Among the 18 remaining specimens, no significant difference in load to failure was observed between the experimental group (n = 11) and the control group (n = 7) (1,006.5 ± 332.1 versus 932.8 ± 229.1 N, respectively;  = .567).

Conclusions: Significantly greater gap displacement was observed in the standard Krackow repair group compared with the augmented Krackow group at all cyclic loading intervals. This suggests that the Krackow transosseous procedure augmented with high-strength suture tape is biomechanically viable for inferior pole patellar tendon repair.

Clinical Relevance: This biomechanical study supports the use of high-strength suture tape augmentation of Krackow transosseous repair for inferior pole patellar tendon rupture.