Nho Shane J, Frank Rachel M, Van Thiel Geoffrey S, Wang Fan Chia, Wang Vincent M, Provencher Matthew T, Verma Nikhil N
Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois 60612, USA.
Am J Sports Med. 2010 Jul;38(7):1405-12. doi: 10.1177/0363546509359069. Epub 2010 Apr 1.
Arthroscopic repair of anterior Bankart lesions is typically done with single-loaded suture anchors tied with simple stitch configuration.
The knotless suture anchor will have similar biomechanical properties compared with two types of conventional suture anchors.
Controlled laboratory study.
Fresh-frozen shoulders were dissected and an anteroinferior Bankart lesion was created. For phase 1, specimens were randomized into either simple stitch (SSA) or knotless suture anchors (KSA) and loaded to failure. For phase 2, specimens were randomized into 1 of 4 repair techniques and cyclically loaded then loaded to failure: (1) SSA, (2) suture anchor with horizontal mattress configuration, (3) double-loaded suture anchor with simple stitch configuration, or (4) KSA. Data recorded included mode of failure, ultimate load to failure, load at 2 mm of displacement, as well as displacement during cyclical loading.
For phase 1, the load required to 2 mm displacement of the repair construct was significantly greater in SSA (66.5 +/- 21.7 N) than KSA (35.0 +/- 12.5 N, P = .02). For phase 2, there was a statistically significant difference in ultimate load to failure among the 4groups, with both the single-loaded suture anchor with simple stitch (184.0 +/- 64.5 N), horizontal mattress stitch (189.0 +/- 65.3N), and double-loaded suture anchor with simple stitch (216.7 +/- 61.7 N) groups having significantly (P < .05) higher loads than the knotless group (103.9 +/- 52.8 N). There was no statistically significant difference (P > .05) among the 4 groups in displacement after cyclical loading or load at 2 mm of displacement.
Both knotless and simple anchor configurations demonstrated similar single loads to failure (without cycling); however, the knotless device required less single load to displace 2 mm. All repair stitches, including simple, horizontal, and double-loaded performed similarly.
The findings may suggest that with cyclical loading up to 25 N there is no difference in gapping greater than 2mm, but a macrotraumatic event may demonstrate a difference in fixation during the initial postoperative period. Additional in vivo studies are needed to determine whether these differences affect the integrity of the repair construct and, ultimately, the clinical outcome.
关节镜下修复前盂唇Bankart损伤通常采用单股缝线锚钉并以简单缝合方式打结。
与两种传统缝线锚钉相比，无结缝线锚钉具有相似的生物力学性能。
对照实验室研究。
解剖新鲜冷冻的肩关节并制造前下盂唇Bankart损伤。在第一阶段，将标本随机分为简单缝合（SSA）组或无结缝线锚钉（KSA）组并加载至失效。在第二阶段，将标本随机分为4种修复技术中的1种，先进行循环加载然后加载至失效：（1）SSA，（2）采用水平褥式缝合方式的缝线锚钉，（3）采用简单缝合方式的双股缝线锚钉，或（4）KSA。记录的数据包括失效模式、失效时的极限载荷、位移2 mm时的载荷以及循环加载过程中的位移。
在第一阶段，修复结构位移2 mm所需的载荷在SSA组（66.5±21.7 N）显著大于KSA组（35.0±12.5 N，P = .02）。在第二阶段，4组之间在失效时的极限载荷方面存在统计学显著差异，采用简单缝合的单股缝线锚钉组（184.0±64.5 N）、水平褥式缝合组（189.0±65.3 N）和采用简单缝合的双股缝线锚钉组（216.7±61.7 N）的载荷均显著高于无结组（103.9±52.8 N）（P < .05）。4组在循环加载后的位移或位移2 mm时的载荷方面无统计学显著差异（P > .05）。
无结和简单锚钉构型在失效时的单次载荷（无循环）方面表现相似；然而，无结装置位移2 mm所需的单次载荷较小。所有修复缝合方式，包括简单、水平和双股缝合，表现相似。
研究结果可能表明，在高达25 N的循环加载下，间隙大于2 mm时无差异，但在术后初期，重大创伤事件可能显示出固定方面的差异。需要更多的体内研究来确定这些差异是否会影响修复结构的完整性以及最终的临床结果。
