Southern California Permanente Medical Group, Woodland Hills, CA, USA.
Arthroscopy. 2013 Jul;29(7):1149-56. doi: 10.1016/j.arthro.2013.04.011.
To compare the effect of 2 common rotator cuff repair techniques, for smaller tears limited to the use of a single anchor, on tendon morphology in relation to the footprint.
Six matched pairs of human shoulders were dissected, and a standardized 10-mm supraspinatus tendon tear was created. Two single-anchor repairs were performed: simple repair with the anchor on the footprint or inverted-mattress repair with the anchor 1 cm distal-lateral to the footprint. The repaired specimens were frozen in situ with liquid nitrogen. Coronal cross sections through the intact and repaired tendon were made. A digitizer was used to measure variables including tendon area and radius of tendon curvature.
Comparing between repairs, we found significantly more gap formation for the simple repair at the repair cross section (3.67 ± 0.32 mm v 0.68 ± 0.10 mm, P = .00050). The simple repair had less tendon area (38.28 ± 2.50 mm(2)v 58.65 ± 4.06 mm(2), P = .0036) and a smaller radius of curvature (8.47 ± 1.39 mm v 32.51 ± 3.94 mm, P = .0046). For the simple repair, there was significantly more gap formation, less tendon area, and a smaller radius of tendon curvature for all repair cross sections compared with the intact cross sections (P < .05). For the inverted-mattress repair, there was more gap formation compared with the intact condition (P < .05), although it was less than 1 mm on average; for tendon area, radius of curvature, and tendon height, the cross section centered on the repair showed no differences compared with the intact control.
For rotator cuff tears that are 10 mm or smaller and limited to the use of a single anchor, using a distal-lateral anchor position with tape-type suture can provide better maintenance of native tendon morphology and footprint dimensions when compared with repair that uses standard sutures and places the anchor on the footprint.
For smaller tears, the inverted-mattress repair described in this article may provide a relatively improved healing environment compared with a simple repair on the footprint, potentially optimizing the prevention of early tear progression.
比较两种常见的肩袖修复技术（均采用单个锚钉修复，适用于较小的止于单一锚钉的撕裂）对肌腱形态与止点关系的影响。
对 6 对配对的人肩进行解剖，制作一个标准化的 10mm 冈上肌腱撕裂模型。进行两种单锚钉修复：一种是将锚钉置于止点上的简单修复，另一种是将锚钉置于止点外 1cm 处的倒“8”字修复。用液氮原位冷冻修复标本。对完整和修复后的肌腱进行冠状切面。使用数字化仪测量包括肌腱面积和肌腱曲率半径在内的变量。
与修复相比，在修复横截面上，简单修复的间隙形成明显更多（3.67 ± 0.32mm 比 0.68 ± 0.10mm，P =.00050）。简单修复的肌腱面积更小（38.28 ± 2.50mm²比 58.65 ± 4.06mm²，P =.0036），曲率半径更小（8.47 ± 1.39mm 比 32.51 ± 3.94mm，P =.0046）。对于简单修复，与完整横断面对比，所有修复横断面上的间隙形成、肌腱面积更小，肌腱曲率半径更小（P <.05）。对于倒“8”字修复，与完整状态相比，间隙形成更多（P <.05），但平均不超过 1mm；对于肌腱面积、曲率半径和肌腱高度，修复中心的横断面对比完整对照没有差异。
对于 10mm 或更小的肩袖撕裂，且仅限于使用单个锚钉，使用位于锚钉外侧的锚钉位置，与将锚钉置于止点上的修复方式相比，使用带线锚钉的修复方式可以更好地维持肌腱的原始形态和止点的尺寸。
对于较小的撕裂，与在止点上进行简单修复相比，本文描述的倒“8”字修复可能提供了一个相对改善的愈合环境，潜在地优化了对早期撕裂进展的预防。
