Double-Crossed Knotless Suture Anchor Repair of Quadriceps Tendon Rupture

Author(s): Waqas Ali, Javaid Iqbal, Talat Mahmood, Liam Leonard, Paul O'Grady

Quadriceps tendon rupture is an uncommon injury but may result in long term disability if not adequately repaired. Many techniques are described for repair of acute quadriceps tendon rupture, including tendon-to-tendon repair, trans-osseous tunnels, synthetic augmentation, tendon plasty and the use of suture anchors. There is no single accepted surgical treatment. This study's objective was to assess the efficacy of a double-crossed suture anchor repair in the management of quadriceps tendon rupture.

Materials and methods

85 patient attended our institute for surgical management of quadriceps tendon rupture over eight years (2012-2019). Twenty patients were treated with the use of a double-crossed suture anchor fixation. These patients were allowed to weight bear in a hinged knee brace for six weeks following surgery. Eighteen out of twenty patients had one or more predisposing comorbidities, including obesity, diabetes, renal failure, quinolone and steroid use.


Clinical and functional outcomes were recorded during follow up visits prospectively for a mean of one year (10-14 months). The mean knee flexion was 124 degree (120-130). All patients were able to return to activities of daily living (ADL) with a mean of 2 months (1.5-3 months) and return to work at a mean of 6 months (4-8 months). The mean Tegner, Cincinnati and Lysholm score at the latest follow up were 2.8 (0-5), 79.2 (60-88) and 90 (70-100), respectively. There were no early complications. There was no re-tear reported at the latest follow up.


The double-crossed suture anchor fixation is a safe and effective treatment option in managing quadriceps tendon ruptures.

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