Department of Sports Medicine and Arthroscopy Surgery, Fudan University Sports Medicine Center, Huashan Hospital, Shanghai, China.
Orthop Surg. 2009 Feb;1(1):1-5. doi: 10.1111/j.1757-7861.2008.00001.x.
To evaluate results of margin convergence versus suture anchors in rotator cuff repair, and to determine which method is mechanically superior.
Eighteen kangaroo shoulders were randomly divided into three groups (n = 6). A full thickness tendon defect 1.0 cm × 1.5 cm in size was created in the supraspinatus tendon at humeral insertion, simulating a massive rotator cuff tear. Three different techniques were employed for rotator cuff repair: (i) Mitek GII suture anchor alone (Group 1); (ii) margin convergence alone (Group 2); and (iii) margin convergence plus Mitek GII suture anchor (Group 3). Combined loads were applied to each specimen. After completion of cyclic loading, the construct was loaded to failure. ANOVA and LSD (Least Significant Difference) multiple comparisons of the means were applied to results.
Cyclic load testing showed progressive gap formation in each repaired specimen with increasing cycles. Group 1 reached 50% failure at an average of 34 cycles, Group 2 at 75 cycles and Group 3 at 73 cycles. There were significant difference between Groups 1 and 2, and Groups 1 and 3 (P ≤ 0.001). After 100 loading cycles, the average gap size was 6.8 mm, 6.1 mm and 4.7 mm in Groups 1, 2 and 3, respectively. There was a significant difference between Groups 1 and 3 (P ≤ 0.015). All specimens eventually reached failure.
Rotator cuff repairs with margin convergence +/- suture anchor were far stronger than suture anchor alone, both in gap formation and ultimate failure load. However, progressive gap formation with cyclic loading seems inevitable after cuff repair, which may facilitate clinical understanding of the phenomena of re-tear or residual defect.
评估肩袖修复中边缘收敛与缝线锚钉的效果，并确定哪种方法在机械性能上更优。
18 只袋鼠肩被随机分为 3 组（每组 6 只）。在肱骨附着处的冈上肌腱处创建一个 1.0cm×1.5cm 的全层肌腱缺损，模拟巨大肩袖撕裂。采用 3 种不同的技术进行肩袖修复：（i）单独使用 Mitek GII 缝线锚钉（第 1 组）；（ii）单独使用边缘收敛（第 2 组）；和（iii）边缘收敛加 Mitek GII 缝线锚钉（第 3 组）。对每个标本施加组合载荷。完成循环加载后，将构建物加载至失效。对结果进行方差分析和 LSD（最小显著差异）多重比较。
循环加载测试显示，每个修复标本的间隙随着循环次数的增加而逐渐形成。第 1 组在平均 34 个循环时达到 50%失效，第 2 组在 75 个循环时达到 75%失效，第 3 组在 73 个循环时达到 75%失效。第 1 组和第 2 组、第 1 组和第 3 组之间有显著差异（P≤0.001）。在 100 个加载循环后，第 1、2 和 3 组的平均间隙大小分别为 6.8mm、6.1mm 和 4.7mm。第 1 组和第 3 组之间有显著差异（P≤0.015）。所有标本最终均达到失效。
与单独使用缝线锚钉相比，边缘收敛加/-缝线锚钉的肩袖修复在间隙形成和最终失效载荷方面都要强得多。然而，肩袖修复后循环加载时不可避免地会出现渐进性间隙形成，这可能有助于临床理解再撕裂或残留缺陷的现象。
