Department of Orthopaedic Surgery, University of California, San Diego, California, USA.
Arthroscopy. 2010 Sep;26(9 Suppl):S127-33. doi: 10.1016/j.arthro.2010.02.035.
Our purpose was to investigate the importance of medial-row knot tying to mechanical stability in a double-row rotator cuff repair by comparing a knotless construct with transtendon anchor passage versus a similar construct implementing medial knots.
A standard defect was created in the infraspinatus tendons of 14 bovine humeri. All defects were repaired with 2 medial and 2 lateral anchors (SutureCross System; KFx Medical, Carlsbad, CA). The medial anchors were either placed by transtendon passage in a knotless construct or placed directly into bone with needle passage of suture to create bursal-sided knots medially. Constructs were subjected to a cyclic loading protocol and then loaded to failure.
The medially knotted constructs had a statistically higher stiffness at both the initial and final cycles (P < .001 and P < .001, respectively) and a lower displacement during cyclic loading (P < .02). There were strong trends toward decreased gauge displacement (P = .12) and decreased cycles to 3 mm of displacement (P = .07) in the medially knotted group. Maximal yield strength was greater in the medially knotted group (350 +/- 270 N v 650 +/- 530 N), although this was not found to be statistically significant (P = .5).
Our data suggest that creation of medial knots increases construct stiffness and stability in arthroscopic double-row cuff repair. This is likely because of increased load transfer to the lateral anchor and suture-tendon interface in the knotless construct.
Medial knots create increased mechanical stability that theoretically may improve rotator cuff healing. This mechanical advantage must be weighed against surgical efficiency, with consideration given to factors such as tissue quality.
本研究旨在比较无结缝线构建与经腱中穿行缝线构建内侧结的类似构建，通过对比分析，探讨在双排肩袖修复中缝线结在中间行中的重要性对机械稳定性的影响。
在 14 个牛肱骨的冈下肌腱中创建了一个标准缺损。所有缺损均采用 2 个内侧和 2 个外侧锚（SutureCross 系统；KFx Medical，加利福尼亚州卡尔斯巴德）进行修复。内侧锚要么通过无结缝线构建经腱中穿行，要么直接穿过缝线将针穿过进入骨中，在腱旁侧中间形成结。构建物受到循环加载方案的作用，然后加载至失效。
在初始和最终循环时，内侧结构建物的刚度均具有统计学意义（P <.001 和 P <.001），且在循环加载过程中的位移较小（P <.02）。在内侧结组中，有减小测量位移（P =.12）和减小达到 3mm 位移的循环次数（P =.07）的强烈趋势。内侧结组的最大屈服强度更高（350 ± 270 N 比 650 ± 530 N），尽管这并未显示出统计学意义（P =.5）。
我们的数据表明，在关节镜下双排肩袖修复中，形成内侧结可增加构建物的刚度和稳定性。这可能是由于无结缝线构建中增加了向外侧锚和缝线-肌腱界面的负载传递。
内侧结可产生增加的机械稳定性，理论上可改善肩袖愈合。必须权衡这种机械优势与手术效率，同时考虑组织质量等因素。
