Suture Tape Reduces Quadriceps Tendon Repair Gap Formation Compared to High Strength Suture: A Cadaveric Biomechanical Analysis

Abstract Purpose The purpose of this study was to compare the biomechanical differences between quadriceps tendon (QT) repair with high-strength suture (HSS) versus suture tape (ST) with varying number of suture passes. Methods 28 fresh-frozen QTs were randomized into two groups: i) HSS; or ii) ST; specimens were then further randomized into subgroups of either four or six suture passes. Specimens were secured within a materials testing system and a 150 N preload was applied 10s followed by a cyclic loading protocol between 50N and 250N for 1000 cycles. Video was utilized to follow tracking markers used to calculate the magnitude of tendon displacement. Two-way univariate ANOVA was used to determine the effect of suture type and passes on the displacement after preloading and mixed repeated-measures ANOVA was used to determine the effect of suture type and passes on displacement following cyclic loading. Results There were large increases in displacement following the preload across all conditions (7.82±3.64 mm), with no statistically significant differences between groups. There was a significant difference in the mean (±SD) displacement between the ST (5.24±2.82 mm) and HSS (7.93±2.91 mm) starting at 200 cycles, which became more pronounced with successive testing out to 1000 cycles (p=0.0≤21). There were no significant difference with respect to the number of suture or tape passes.results Conclusions Following preloading at 150N, significant displacement occurred in both quadriceps tendon repair groups. ST demonstrated significantly less displacement than HSS under cyclic loading and had greater ultimate failure loads.conclusion Clinical Relevance When performing quadriceps tendon repair, emphasis should be placed on appropriate pre-tensioning of sutures to at least 150N prior to knot-tying. Additionally, where available, suture tape should be utilized over high-strength suture to reduce further cyclic elongation and improve ultimate failure loads.