Orthopaedic Biomechanics Laboratory, VA Healthcare System and University of California, Irvine, California, USA.
Arthroscopy. 2012 Sep;28(9):1237-45. doi: 10.1016/j.arthro.2012.02.016. Epub 2012 May 17.
The purpose of this study was to compare the biomechanical characteristics of a massive L-shaped retracted rotator cuff tear repaired with either soft-tissue side-to-side sutures or margin convergence anchorage to bone.
Eight matched pairs of cadaveric shoulders were used. The supraspinatus and infraspinatus were secured in a clamp at 30° of glenohumeral abduction. The subscapularis was secured in a separate clamp, and a constant load was applied. A massive L-shaped rotator cuff tear of the supraspinatus and infraspinatus tendon was created. In all specimens the posterior aspect of the tear was repaired by a transosseous-equivalent technique. In 1 group we placed 2 margin convergence sutures between the supraspinatus and the rotator interval. In the comparison group, a suture anchor was inserted at the anterior attachment of the rotator cable. Margin convergence anchorage to bone was then performed between the supraspinatus and the rotator interval. Each specimen was tested with an Instron machine (Instron, Canton, MA) and a video digitizing system. A paired t test was used for statistical analysis.
Margin convergence anchorage to bone decreased gap formation at cycle 1, cycle 30, and yield load across the entire footprint (P < .05). In both constructs the anterior gap was greater than the posterior gap at cycle 1, cycle 30, and yield load (P < .05). Margin convergence anchorage to bone decreased hysteresis and increased stiffness during the first cycle and increased yield load (P < .05).
Using margin convergence anchorage to bone to restore the anterior attachment of the rotator cable decreased gap formation across the entire footprint and improved biomechanical properties for cycle 1 and yield load compared with soft-tissue margin convergence for massive rotator cuff repairs.
Repairing the anterior rotator cuff with margin convergence anchorage to bone may improve clinical outcomes of an L-shaped massive tear repair.
本研究旨在比较使用软组织侧对侧缝线或边缘汇聚锚定骨修复巨大 L 型回缩肩袖撕裂的生物力学特征。
使用 8 对匹配的尸体肩。将冈上肌和冈下肌在肩肱关节外展 30°的情况下固定在夹具中。将肩胛下肌固定在单独的夹具中，并施加恒定的负荷。创建冈上肌和冈下肌腱的巨大 L 型肩袖撕裂。在所有标本中，撕裂的后缘均采用经骨等效技术修复。在一组中，我们在冈上肌和旋转间隔之间放置了 2 个边缘汇聚缝线。在对照组中，在前旋肌腱的前附着处插入缝线锚钉。然后在冈上肌和旋转间隔之间进行边缘汇聚锚定骨。每个标本均使用 Instron 机器（Instron，马萨诸塞州坎顿）和视频数字化系统进行测试。采用配对 t 检验进行统计学分析。
边缘汇聚锚定骨减少了循环 1、30 和整个足迹屈服载荷时的间隙形成（P <.05）。在两种结构中，在前循环 1、30 和屈服载荷时，前间隙均大于后间隙（P <.05）。边缘汇聚锚定骨减少了第一周期和屈服载荷的滞后和增加了刚度（P <.05）。
使用边缘汇聚锚定骨修复旋转电缆的前附着可以减少整个足迹的间隙形成，并改善生物力学性能，与巨大肩袖修复的软组织边缘汇聚相比，在第一周期和屈服载荷方面都有改善。
使用边缘汇聚锚定骨修复前肩袖可能会改善 L 型巨大撕裂修复的临床结果。
