An In Vitro Biomechanical Study of Quadriceps Tendon Reconstruction with Synthetic Mesh: A Novel Technique

Background/Objectives: Quadriceps tendon (QT) rupture in non-native knees (such as post-total knee arthroplasty) is catastrophic. Primary repair of the poor-quality tendon with significant gapping has led to a high failure rate and poor functional outcomes. Synthetic polypropylene mesh graft (PMG) reconstruction of QT tears has been introduced to address this issue. This cadaveric study compared the biomechanical performance of a novel synthetic mesh reconstruction technique for QT rupture with the commonly used patellar transosseous tunnel fixation (TTF) technique. Methods: Cadaveric patellar bone-quadriceps tendons were harvested with the QT cut at the superior pole of the patella to simulate tendon rupture. The tears were repaired using either patellar TTF or PMG reconstruction. After repair, each specimen was subjected to 250 cycles of biomechanical cyclic loading. Early and late local displacement (gap between the PMG and superior pole of the patella), overall construct elongation, ultimate tensile load, and failure mode were recorded. Results: Displacements measured at the 20th and 250th cycles demonstrated significantly smaller displacement at the patellar bone–mesh fixation site for the PMG reconstruction group (though it should be noted that this measurement did not account for movement at the tendon–mesh interface). Overall construct elongation was significantly lower in the new technique compared to TTF. The new technique also demonstrated a significantly higher ultimate tensile load. Conclusions: The novel technique of the composite PMG construct—utilising synthetic mesh, bone cement, and K-wire augmentation to reconstruct the QT—has demonstrated enhanced biomechanical performance. The construct shows biomechanical potential and warrants further evaluation in non-native knees and clinical settings.