Saturday February 24, 1996

New surgical technique avoids complications in tendon repair

A new surgical technique for patella/quadriceps tendon repair allows immediate range of motion and full weightbearing without the concern for repeat rupture or fatigue failure of metal cerclage wiring, according to a study presented here today.

The technique-using readily available suture material (double #5 Ethibond) in cerclage to protect a standard repair-requires less than 10 minutes of additional tourniquet time.

Following this repair, patients are better able to avoid the complications associated with inactivity and immobilization. All 10 patients in the study returned to work earlier than expected and were able to drive a car.

For this new technique, orthopaedic surgeons used a longitudinal midline incision beginning three finger breadths superior to the patella and extending to the tibial tuberosity. The pathology was defined.

The study reported that a horizontal trough was made in the patella and three evenly spaced drill holes were made within the trough. Two #5 Ethibond Bunnell sutures were applied to the medial and lateral aspects of the tendon, and passed through the drill holes.

The ruptured tendon was pulled into the 1 cm deep trough and the Bunnell sutures tied over bone in the degree of flexion which allowed full tendon-bone apposition. Torn medial and lateral parapatellar tissues were reapproximated with #1 PDS absorbable suture.

The study said double #5 Ethibond was passed through a drill hole made 1 cm posterior to the tibial tubercle, passed up the medial retinaculum, through the quadriceps tendon superiorly, and then down the lateral parapatellar retinaculum.

The knee was flexed to 90 degrees, and the cerclage suture tied such that the knot was in the soft tissue of the superior aspect of the lateral compartment. Soft tissue was then sutured over the cerclage suture to maintain its parapatellar position and prevent bowstringing.

The knee was then placed through a full range of motion. The study noted that the cerclage suture fully protected the repair in each case. The cerclage suture was lax in extension, but tight in flexion.

Co-authors of the study are Samuel A. Hoisington, MD, and Kenneth W. Taylor, MD, both of the Bronx, N.Y.; and David R. Bachkosky, PA-C and Michael J. Axe, MD, both of Newark, Del.

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