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J Knee Surg 2023; 36(11): 1191-1199
DOI: 10.1055/s-0042-1750060
Original Article

Do Patellar Tendon Repairs Have Better Outcomes than Quadriceps Tendon Repairs? A Prospective Cohort Analysis

Sercan Yalcin 
1   Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland Clinic Sports Medicine, Garfield Heights, Ohio
,
Brett McCoy
2   Department of Sports Medicine, Cleveland Clinic Ringgold standard institution, Cleveland, Ohio
,
Lutul D. Farrow
1   Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland Clinic Sports Medicine, Garfield Heights, Ohio
,
Carrie Johnson
2   Department of Sports Medicine, Cleveland Clinic Ringgold standard institution, Cleveland, Ohio
,
Morgan H. Jones
2   Department of Sports Medicine, Cleveland Clinic Ringgold standard institution, Cleveland, Ohio
,
Michael Kolczun
1   Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland Clinic Sports Medicine, Garfield Heights, Ohio
,
Brian Leo
2   Department of Sports Medicine, Cleveland Clinic Ringgold standard institution, Cleveland, Ohio
,
Anthony Miniaci
2   Department of Sports Medicine, Cleveland Clinic Ringgold standard institution, Cleveland, Ohio
,
Robert Nickodem
1   Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland Clinic Sports Medicine, Garfield Heights, Ohio
,
Richard Parker
1   Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland Clinic Sports Medicine, Garfield Heights, Ohio
,
Alfred Serna
2   Department of Sports Medicine, Cleveland Clinic Ringgold standard institution, Cleveland, Ohio
,
Kim Stearns
1   Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland Clinic Sports Medicine, Garfield Heights, Ohio
,
Greg Strnad
1   Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland Clinic Sports Medicine, Garfield Heights, Ohio
,
James Williams
2   Department of Sports Medicine, Cleveland Clinic Ringgold standard institution, Cleveland, Ohio
,
Jin Yuxuan
3   Department of Quantitative Health Sciences, Cleveland Clinic Ringgold standard institution, Cleveland, Ohio
,
Kurt P. Spindler
1   Orthopaedic and Rheumatologic Institute, Cleveland Clinic, Cleveland Clinic Sports Medicine, Garfield Heights, Ohio
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Abstract

Patellar tendon (PT) and quadriceps tendon (QT) ruptures represent significant injuries and warrant surgical intervention in most patients. Outcome data are predominantly retrospective analyses with low sample sizes. There are also minimal data comparing QT and PT repairs and the variables impacting patient outcomes. The level of evidence of the study is level II (prognosis). From the prospective OME cohort, 189 PT or QT repairs were performed between February 2015 and October 2019. Of these, 178 were successfully enrolled (94.2%) with 1-year follow-up on 141 (79.2%). Baseline demographic data included age, sex, race, BMI, years of education, smoking status, and baseline VR-12 MCS score. Surgical and follow-up data included surgeon volume, fixation technique, baseline, and 1-year Knee Injury and Osteoarthritis Outcome Score-Pain (KOOS-Pain), Knee Injury and Osteoarthritis Outcome Score—Physical Function (KOOS-PS), and 1-year Patient Acceptable Symptom State (PASS) scores and complications. Multivariable regression analysis was utilized to identify prognosis and significant risk factors for outcomes—specifically, whether KOOS-Pain or KOOS-PS were different between QT versus PT repairs. There were 59 patients in the PT cohort and 82 patients in QT cohort. Baseline demographic data demonstrated that PT cohort was younger (45.1 vs. 59.5 years, p <0.001), included significantly fewer patients of White race (51.7 vs. 80.0%, p = 0.001), lesser number of years of education (13.9 vs. 15.2 years, p = 0.020), a higher percentage of “high” surgeon volume (72.9% vs. 43.9%, p = 0.001) and 25.4% of PT repairs had supplemental fixation (QT had zero, p <0.001). Multivariable analysis identified gender (female-worse, p = 0.001), years of education (higher-better, p = 0.02), and baseline KOOS-Pain score (higher-better, p <0.001) as the risk factors that significantly predicted KOOS-Pain score. The risk factors that significantly predicted KOOS-PS were gender (female worse, p = 0.033), race (non-White-worse, p <0.001), baseline VR-12 MCS score (higher-better, p <0.001), and baseline KOOS-PS score (higher better, p = 0.029). KOOS-Pain and KOOS-PS scores improved after both QT and PT repairs. Patient reported pain and function at 1 year were similar between PT and QT repairs after adjusting for known risk factors. Multivariable analysis identified female gender and low baseline KOOS scores as predictors for worse outcomes.

Keywords

patellar tendon rupture - quadriceps tendon rupture - tendon repair - patient-reported outcomes


Publication History

Received: 27 January 2022

Accepted: 26 April 2022

Article published online:
07 July 2022

© 2022. Thieme. All rights reserved.

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333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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