Department of Orthopaedics and Traumatology, Mustafa Kemal University, Hatay, Turkey.
Arthroscopy. 2012 May;28(5):681-7. doi: 10.1016/j.arthro.2011.10.026. Epub 2012 Jan 30.
To biomechanically compare anterior cruciate ligament (ACL) tibial bony avulsion fixation by suture anchors, EndoButtons (Smith & Nephew, Andover, MA), and high-strength sutures subjected to cyclic loading.
Type III tibial eminence fractures were created in 49 ovine knees, and 7 different types of repairs were performed. Each repair group contained 7 specimens. The repair groups were as follows: No. 2 FiberWire (Arthrex, Naples, FL); No. 2 UltraBraid (Smith & Nephew); No. 2 MaxBraid (Arthrotek, Warsaw, IN); No. 2 Hi-Fi (ConMed Linvatec, Largo, FL); No. 2 OrthoCord (DePuy Mitek, Raynham, MA); Ti-Screw suture anchor (Arthrotek); and titanium EndoButton. These constructs were cyclically loaded (500 cycles, 0 to 100 N, 1 Hz) in the direction of the native ACL and loaded to failure (100 mm/min). Endpoints included ultimate failure load (in Newtons); pullout stiffness (in Newtons per millimeter); cyclic displacement (in millimeters) after 100 cycles, between 100 and 500 cycles, and after 500 cycles; and mode of failure. Bone density testing was performed in all knees.
Bone density was not different among the groups. The EndoButton group had a higher ultimate failure load than the FiberWire, UltraBraid, Hi-Fi, and suture anchor groups (P < .05). The MaxBraid and OrthoCord groups had higher failure loads than the suture anchor group (P < .05). The MaxBraid group also had a higher failure load than the Hi-Fi group (P < .05). Stiffness was not statistically different for the various tested constructs. After 100 cycles, the EndoButton group had less displacement than the FiberWire, UltraBraid, MaxBraid, and Hi-Fi groups (P < .05). The suture anchor group had less displacement than the Hi-Fi and FiberWire groups (P < .05). The displacements of the different tested constructs between 100 and 500 cycles and total displacements after 500 cycles were not statistically different. The predominant failure mode was suture rupture.
Under cyclic loading conditions in an ovine model, EndoButton fixation of tibial eminence fractures provided greater initial fixation strength than suture anchor fixation or fixation with various high-strength sutures except for OrthoCord.
During initial cyclic loading of ACL tibial eminence fractures, the strength of the repair construct should be taken into consideration because conventional suture repair even with ultrahigh-molecular-weight polyethylene sutures may not provide enough strength.
通过生物力学比较前交叉韧带（ACL）胫骨骨撕脱固定用缝线锚钉、EndoButtons（Smith & Nephew，安多弗，MA）和高强度缝线在循环载荷下的情况。
在 49 个羊膝关节中创建了 III 型胫骨隆起骨折，进行了 7 种不同类型的修复。每个修复组包含 7 个标本。修复组如下：No.2 FiberWire（Arthrex，那不勒斯，FL）；No.2 UltraBraid（Smith & Nephew）；No.2 MaxBraid（Arthrotek，华沙，IN）；No.2 Hi-Fi（ConMed Linvatec，拉戈，FL）；No.2 OrthoCord（DePuy Mitek，雷纳姆，MA）；Ti-Screw 缝线锚钉（Arthrotek）和钛质 EndoButton。这些结构在 ACL 原生方向上进行循环加载（500 个循环，0 至 100 N，1 Hz），直至失效（100 mm/min）。终点包括最终失效载荷（牛顿）；拔出刚度（牛顿/毫米）；100 个循环后、100 至 500 个循环之间以及 500 个循环后的循环位移（毫米）；以及失效模式。对所有膝关节进行骨密度测试。
各组骨密度无差异。与 FiberWire、UltraBraid、Hi-Fi 和缝线锚钉组相比，EndoButton 组的最终失效载荷更高（P<0.05）。MaxBraid 和 OrthoCord 组的失效载荷高于缝线锚钉组（P<0.05）。MaxBraid 组的失效载荷也高于 Hi-Fi 组（P<0.05）。不同测试结构的刚度无统计学差异。100 个循环后，EndoButton 组的位移小于 FiberWire、UltraBraid、MaxBraid 和 Hi-Fi 组（P<0.05）。缝线锚钉组的位移小于 Hi-Fi 和 FiberWire 组（P<0.05）。100 至 500 个循环之间和 500 个循环后的总位移的不同测试结构之间的位移无统计学差异。主要失效模式为缝线断裂。
在羊模型的循环载荷条件下，与缝线锚钉固定或各种高强度缝线固定（除 OrthoCord 外）相比，EndoButton 固定胫骨隆起骨折提供了更大的初始固定强度。
在前交叉韧带胫骨隆起骨折的初始循环加载过程中，应考虑修复结构的强度，因为即使使用超高分子量聚乙烯缝线的传统缝线修复也可能无法提供足够的强度。
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