Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea.
Arthroscopy. 2013 Mar;29(3):485-90. doi: 10.1016/j.arthro.2012.10.011. Epub 2013 Jan 11.
This study compared the status of suture knots immediately after repair and after shoulder motion to evaluate the possibility of movement-induced knot migration to a location nearer the glenoid.
We included 10 shoulders from 5 cadavers in the study. After posterior capsulotomy, a Bankart lesion was created. A capsulolabral repair was then performed with 3 knot-tying suture anchors. All knots were positioned on the capsular side, far from the articular surface. After the repair was complete, a photograph was taken with a metal rod placed to reference absolute distance. After passive pendulum motion was applied, another photograph was taken. The length of the suture strand from the knot base to the anchor insertion site was measured during both the initial repair and post-motion periods.
Initial distances were 4.83 ± 1.09 mm for the inferior knot, 4.70 ± 0.97 mm for the middle knot, and 3.84 ± 1.25 mm for the superior knot. After motion, the distances were 3.52 ± 1.21 mm (P = .01), 3.07 ± 0.81 mm (P < .001), and 2.69 ± 1.18 mm (P = .016), respectively. Additional observations showed changes in direction and security of the knot. The change in knot direction from an initial orientation facing the capsular side to a new orientation facing the glenoid was observed in 5 of 10 inferior, 7 of 10 middle, and 6 of 10 superior knots. In addition, knot loosening was noted for the last half-hitches in 4 inferior knots and 1 middle knot.
Intentional placement of suture knots away from the joint surface was not maintained after motion at the shoulder.
Movement-induced knot migration may be detrimental to articular cartilage in the event that a knot becomes interposed between the glenoid and humeral head.
本研究比较了修复后和肩关节运动后缝线结的状态，以评估缝线结在运动过程中向更靠近关节盂位置移动的可能性。
我们纳入了 5 具尸体 10 个肩关节进行研究。完成后关节囊切开后，创建 Bankart 损伤。然后使用 3 个缝线锚钉进行肩袖下修补术。所有缝线结都位于关节囊侧，远离关节面。修复完成后，放置金属棒拍照以参考绝对距离。施加被动摆荡运动后，再拍摄一张照片。在初始修复和运动后两个时期，测量缝线结底部到锚钉插入部位的缝线长度。
初始时，下缝线结的距离为 4.83 ± 1.09mm，中缝线结的距离为 4.70 ± 0.97mm，上缝线结的距离为 3.84 ± 1.25mm。运动后，距离分别为 3.52 ± 1.21mm（P =.01）、3.07 ± 0.81mm（P <.001）和 2.69 ± 1.18mm（P =.016）。进一步观察发现缝线结的方向和稳定性发生了变化。在 10 个下缝线结中，有 5 个缝线结从最初朝向关节囊的方向改变为新的朝向关节盂的方向；在 10 个中缝线结中，有 7 个缝线结从最初朝向关节囊的方向改变为新的朝向关节盂的方向；在 10 个上缝线结中，有 6 个缝线结从最初朝向关节囊的方向改变为新的朝向关节盂的方向。此外，4 个下缝线结和 1 个中缝线结的最后半结出现松动。
肩部运动后，缝线结有意放置在关节面以外的位置无法维持。
如果缝线结在关节盂和肱骨头之间移动，可能会对关节软骨造成损害。
