Cole Brian J, ElAttrache Neal S, Anbari Ammar
Department of Orthopedics and Anatomy and Cell Biology, Rush University Medical Center, Chicago, Illinois 60612, USA.
Arthroscopy. 2007 Jun;23(6):662-9. doi: 10.1016/j.arthro.2007.02.018.
The goal of rotator cuff repairs is to achieve high initial fixation strength, minimize gap formation, maintain mechanical stability under cyclic loading, and optimize the biology of the tendon-bone interface until the cuff heals biologically to the bone. We have seen an evolution in our approaches to fixing rotator cuff tears from open to mini-open to all arthroscopic. In our arthroscopic techniques, we have also seen a change in the types of anchors and sutures we use and our repair techniques including an evolution in techniques that include single row, double row, and, most recently, transosseous equivalent fixation. Single-row repairs are least successful in restoring the footprint of the rotator cuff and are most susceptible to gap formation. Double-row repairs have an improved load to failure and minimal gap formation. Transosseous equivalent repairs have the highest ultimate load and resistance to shear and rotational forces and the lowest gap formation. This review will discuss the anatomy and biomechanics of a normal rotator cuff, the biomechanical factors that play a role in rotator cuff repairs, the initial fixation repair mechanics, and finally propose an algorithm for rotator cuff fixation based on tissue quality and tear configuration.
肩袖修复的目标是实现高初始固定强度，最小化间隙形成，在循环载荷下保持机械稳定性，并优化肌腱-骨界面的生物学特性，直到肩袖在生物学上愈合至骨。我们见证了肩袖撕裂修复方法从开放手术到小切口手术再到全关节镜手术的演变。在我们的关节镜技术中，我们还看到了所使用的锚钉和缝线类型以及修复技术的变化，包括从单排、双排到最近的经骨隧道等效固定技术的演变。单排修复在恢复肩袖足迹方面最不成功，并且最容易形成间隙。双排修复具有更高的抗断裂载荷和最小的间隙形成。经骨隧道等效修复具有最高的极限载荷以及对剪切力和旋转力的抵抗力，并且间隙形成最少。本综述将讨论正常肩袖的解剖结构和生物力学、在肩袖修复中起作用的生物力学因素、初始固定修复力学，最后基于组织质量和撕裂形态提出一种肩袖固定算法。
