Repair Techniques for Acute Rupture of the Patellar Tendon: A Systematic Review

Background: Multiple techniques exist to repair acute tears of the patellar tendon. Surgical repair is required to reestablish full function of the extensor mechanism of the knee, and optimal results typically occur when the tear is repaired acutely. Purpose: To systematically review the literature to evaluate treatment outcomes and complication rates after acute surgical repair of patellar tendon ruptures using suture anchor repair, transosseous repair, and end-to-end repair. Study Design: Scoping review; Level of evidence, 4. Methods: A systematic review was performed to analyze outcomes after patellar tendon repair in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Potential studies were identified through searches of the Cochrane Central Register of Controlled Trials, PubMed, and Embase. Screening was completed independently by 2 authors, who sought to identify studies published from January 1980 to December 2024 that described the management of acute patellar tendon ruptures. Articles were excluded if they described chronic tears or included cases of patellar tendon ruptures in patients who previously underwent total knee arthroplasty. Clinical outcome data were recorded, including treatment outcomes and complications. Results: Twenty studies analyzing 1161 patients met the inclusion criteria. The most reported repair techniques were suture anchor repair, transosseous repair, and end-to-end repair. Six studies analyzed transosseous repair and found positive postoperative functional outcomes, including mean postoperative Lysholm scores ranging from 84 to 98.08 (any, n = 3). Two studies reported using suture anchors, and each stated a postoperative flexion range of motion >130°, with no complications. Five studies analyzed end-to-end acute patellar tendon rupture repair and reported mean flexion >130° (n = 3), with the most reported complication being wound infections. Eight studies compared multiple techniques for acute patellar tendon rupture repair, and 6 studies showed statistically significant improvements in functional outcome scores when comparing pre- and postoperative scoring within cohorts. Additionally, 5 studies in this group reported complications, with the most common being rerupture, reoperation, skin infections, and deep vein thrombosis. Conclusion: Surgical repair of acute patellar tendon rupture with suture anchor repair, transosseous repair, and end-to-end repair all achieved high healing rates. The majority of surgical options demonstrated good functional outcomes with a low risk of complications, the most common of which related to wound complications and infection.