Department of Orthopaedics, University Hospital of Düsseldorf, Düsseldorf, Germany.
Arthroscopy. 2011 Aug;27(8):1036-47. doi: 10.1016/j.arthro.2011.03.082. Epub 2011 Jun 24.
The aim of this study was to biomechanically compare the cyclic and ultimate failure load (UFL) of 4 widely used techniques for arthroscopically performable suprapectoral tenodesis of the long head of the biceps tendon (LHB).
We used 28 fresh-frozen human cadaveric specimens (mean age, 65 years [range, 43 to 78 years; SD, 6.7 years]; 43% male specimens) to investigate 4 different techniques for LHB tenodesis. All techniques were performed in an open manner, with localization at the entrance of the bicipital groove. Two suture anchor techniques (Healix [DePuy Mitek, Raynham, MA], 5.5 mm, with modified lasso-loop stitch; BioSwiveLock [Arthrex, Naples, FL], 5.5 mm, with interlocking Krackow stitch) and two techniques using tenodesis screws (Bio-Tenodesis screw [Arthrex], 8 × 23 mm; Biceptor [Smith & Nephew, Andover, MA], 8 × 25 mm) were investigated. Under a 10-N preload, an axial cyclic load with 100 cycles, 1-Hz frequency, and 50-N maximum load was applied. UFL was evaluated with an axial traction of 0.2 mm/s. LHB displacement during testing was measured by 3-dimensional photogrammetry.
All techniques had a mean displacement of less than 3 mm after cyclic loading. The highest UFL was measured with the Bio-Tenodesis screw (mean, 218.3 N; range, 134.0 to 313.0 N; SD, 59.7 N) and the lowest with the BioSwiveLock (mean, 111.2 N; range, 60.0 to 156.8 N; SD, 32.3 N). The Healix had the second highest UFL (mean, 187.1 N; range, 144.7 to 245.0 N; SD, 35.5 N), followed by the Biceptor (mean, 173.9 N; range, 147.0 to 209.3 N; SD, 27.2 N). There was no significant difference between the Healix, Bio-Tenodesis screw, and Biceptor (P > .05), but the Healix and Bio-Tenodesis screw had a significantly higher UFL than the BioSwiveLock (P < .01). The failure mode was either suture cutout or failure at the anchor-suture-bone interface or of the tendon itself and was generally dependent on technique.
All techniques resisted cyclic testing without a higher grade of displacement, and all devices except the BioSwiveLock had a satisfactory UFL whereas different failure mechanisms were present. The modified lasso-loop stitch provides sufficient tendon fixation and is equivalent to interference screws.
The lasso-loop suture anchor technique is an appropriate alternative for suprapectoral LHB tenodesis compared with tenodesis screw techniques.
本研究旨在从生物力学角度比较 4 种常用于关节镜下肱二头肌长头腱（LHB）上盂唇固定术的技术的循环和极限失效负荷（UFL）。
我们使用 28 个新鲜冷冻的人体尸体标本（平均年龄，65 岁[范围，43 至 78 岁；标准差，6.7 岁]；43%为男性标本）来研究 4 种不同的 LHB 固定技术。所有技术均以开放性方式进行，在二头肌沟入口处定位。两种缝线锚钉技术（Healix[DePuy Mitek，雷纳姆，马萨诸塞州]，5.5 毫米，改良套索环缝线；BioSwiveLock[Arthrex，那不勒斯，佛罗里达州]，5.5 毫米，带互锁 Krackow 缝线）和两种使用肌腱固定螺钉的技术（Bio-Tenodesis 螺钉[Arthrex]，8×23 毫米；Biceptor[Smith & Nephew，安多弗，马萨诸塞州]，8×25 毫米）。在 10-N 的预加载下，施加 100 次循环、1-Hz 频率和 50-N 最大负荷的轴向循环载荷。以 0.2mm/s 的轴向牵引评估 UFL。测试过程中 LHB 的位移通过三维摄影测量法测量。
所有技术在循环加载后位移均小于 3 毫米。Bio-Tenodesis 螺钉的 UFL 最高（平均，218.3N；范围，134.0 至 313.0N；标准差，59.7N），BioSwiveLock 最低（平均，111.2N；范围，60.0 至 156.8N；标准差，32.3N）。Healix 的 UFL 第二高（平均，187.1N；范围，144.7 至 245.0N；标准差，35.5N），其次是 Biceptor（平均，173.9N；范围，147.0 至 209.3N；标准差，27.2N）。Healix、Bio-Tenodesis 螺钉和 Biceptor 之间没有显著差异（P＞.05），但 Healix 和 Bio-Tenodesis 螺钉的 UFL 明显高于 BioSwiveLock（P＜.01）。失效模式要么是缝线切割，要么是锚钉-缝线-骨界面失效，要么是肌腱本身失效，一般取决于技术。
所有技术在循环测试中均未出现较高程度的位移，除 BioSwiveLock 外，所有装置的 UFL 均令人满意，而不同的失效机制均存在。改良套索环缝线可提供足够的肌腱固定，与干扰螺钉等效。
与肌腱固定螺钉技术相比，改良套索环缝线锚钉技术是一种替代关节镜下肱二头肌长头腱上盂唇固定术的合适方法。
