Ahmad Christopher S, Stewart Andrew M, Izquierdo Rolando, Bigliani Louis U
Center for Shoulder, Elbow, and Sports Medicine, Department of Orthopaedic Surgery, Columbia University, 622 West 168th Street, PH 11th Floor, New York, New York 10032, USA.
Am J Sports Med. 2005 Nov;33(11):1667-71. doi: 10.1177/0363546505278252. Epub 2005 Aug 10.
Although many studies involving rotator cuff repair fixation have focused on ultimate fixation strength and ability to restore the tendon's native footprint, no studies have characterized the stability of the repair with regard to motion between the tendon and repair site footprint.
Suture anchor fixation for rotator cuff repair has greater interface motion between tendon and bone than does transosseous suture fixation.
Controlled laboratory study.
Twelve fresh-frozen human cadaveric shoulders were tested in a custom device to position the shoulder in internal and external rotations with simulated supraspinatus muscle loading. Tendon motion relative to the insertional footprint on the greater tuberosity was determined optically using a digital camera rigidly connected to the humerus, with the humerus positioned at 60 degrees of internal rotation and 60 degrees of external rotation. Testing was performed for the intact tendon, a complete supraspinatus tear, a suture anchor repair, and a transosseous tunnel repair.
Difference in tendon-bone interface motion when compared with the intact tendon was 7.14 +/- 3.72 mm for the torn rotator cuff condition, 2.35 +/- 1.26 mm for the suture anchor repair, and 0.02 +/- 1.18 mm for the transosseous suture repair. The transosseous suture repair demonstrated significantly less motion when compared with the torn rotator cuff and suture anchor repair conditions (P < .05).
Transosseous suture repair compared with suture anchor repair demonstrated superior tendon fixation with reduced motion at the tendon-to-tuberosity interface.
Development of new fixation techniques for arthroscopic and open rotator cuff repairs should attempt to minimize interface motion of the tendon relative to the tuberosity.
尽管许多关于肩袖修复固定的研究都集中在最终固定强度和恢复肌腱天然附着点的能力上，但尚无研究对肌腱与修复部位附着点之间运动方面的修复稳定性进行描述。
肩袖修复的缝线锚钉固定与经骨缝线固定相比，肌腱与骨之间的界面运动更大。
对照实验室研究。
使用定制装置对12个新鲜冷冻的人体尸体肩部进行测试，通过模拟冈上肌负荷使肩部进行内旋和外旋。使用刚性连接到肱骨的数码相机，在肱骨处于60度内旋和60度外旋时，以光学方式确定肌腱相对于大结节上插入附着点的运动。对完整肌腱、完全性冈上肌撕裂、缝线锚钉修复和经骨隧道修复进行测试。
与完整肌腱相比，肩袖撕裂状态下肌腱-骨界面运动差异为7.14±3.72毫米，缝线锚钉修复为2.35±1.26毫米，经骨缝线修复为0.02±1.18毫米。与肩袖撕裂和缝线锚钉修复状态相比，经骨缝线修复的运动明显更少（P<.05）。
与缝线锚钉修复相比，经骨缝线修复在肌腱-结节界面处具有更好的肌腱固定效果，且运动减少。
关节镜和开放性肩袖修复新固定技术的开发应尝试尽量减少肌腱相对于结节的界面运动。
