Jacksonville Orthopaedic Institute, Florida, USA.
Arthroscopy. 2011 Apr;27(4):471-8. doi: 10.1016/j.arthro.2010.11.006.
To evaluate the effect of the addition of 2 horizontal mattress knots to the medial row of a knotless rotator cuff construct on the biomechanical properties in terms of both cyclic and failure testing parameters in an external rotation model.
In 8 fresh-frozen human cadaveric shoulders, a knotless transosseous repair was performed, whereas in 8 contralateral matched-pair specimens, 2 horizontal mattress knots were added to the medial-row fixation. A custom jig was used that allowed external rotation (0° to 30°) with loading. A materials testing machine was used to cyclically load repairs from 0 to 180 N for 30 cycles and then to failure. Video digitizing software was used for analysis. Data from paired specimens were compared by use of paired Student t tests.
Ultimate load to failure was significantly higher in the modified construct (549 N v 311 N, P = .01). Linear stiffness in the first cycle, at the 30th cycle, and at failure was significantly higher (P = .02, P = .02, and P = .04, respectively) in the modified construct as well. Energy absorbed by the repaired tissue was significantly less in the modified construct at the first cycle, at the 30th cycle, and at ultimate load to failure (P = .03, P = .02, and P = .04, respectively). Significantly greater anterior gap formation occurred with the knotless technique at the first cycle (4.55 v 1.35) and 30th cycle (7.67 mm v 1.77 mm) (P = .02).
The modified construct shows improved biomechanical properties when allowing for external rotation during high-load testing. Using an additional horizontal mattress from separate sutures in the medial-row anchors helps to neutralize forces experienced by the repair.
The addition of medial-row fixation to a knotless construct will enhance the stability of rotator cuff repairs with the goal of improved patient outcomes.
评估在外部旋转模型中，对于无结肩袖修复的内侧排缝线增加 2 个水平褥式结，对循环和失效测试参数的生物力学性能的影响。
在 8 个新鲜冷冻的人体尸体肩部中，进行了无结经骨修复，而在 8 个对侧配对标本中，内侧排缝线固定增加了 2 个水平褥式结。使用定制夹具，允许外部旋转（0°至 30°）并加载。使用材料试验机，对修复物进行从 0 到 180N 的循环加载 30 个周期，然后进行失效测试。使用视频数字化软件进行分析。通过配对学生 t 检验比较配对标本的数据。
改良结构的最终失效负荷明显更高（549N 比 311N，P=0.01）。在改良结构中，第一周期、第 30 周期和失效时的线性刚度也明显更高（P=0.02，P=0.02 和 P=0.04）。在第一周期、第 30 周期和最终失效负荷时，修复组织吸收的能量在改良结构中明显更少（P=0.03，P=0.02 和 P=0.04）。在第一周期（4.55 比 1.35）和第 30 周期（7.67mm 比 1.77mm）时，无结技术的前间隙形成明显更大（P=0.02）。
改良结构在允许高负荷测试时进行外部旋转时显示出改善的生物力学性能。在内侧排缝线锚钉中使用单独缝线的附加水平褥式结有助于中和修复体所承受的力。
在无结结构中增加内侧排缝线固定将增强肩袖修复的稳定性，以改善患者的结果。
