Ettinger Max, Dratzidis Antonios, Hurschler Christof, Brand Stephan, Calliess Tilman, Krettek Christian, Jagodzinski Michael, Petri Maximilian
Maximilian Petri, Trauma Department, Hannover Medical School, Carl-Neuberg-Strassße 1, D-30625 Hannover, Germany.
Am J Sports Med. 2013 Nov;41(11):2540-4. doi: 10.1177/0363546513500633. Epub 2013 Aug 27.
Ruptures of the patellar tendon are debilitating injuries requiring surgical repair. Reliable data about the most appropriate suture technique and suture material are missing. The standard procedure consists of refixing the tendon with sutures in transpatellar tunnels, sometimes combined with augmentation.
Suture anchors provide at least equal results concerning gap formation during cyclic loading and ultimate failure load compared with transosseous suture repair.
Controlled laboratory study.
A total of 30 human cadaveric patellar tendons underwent tenotomy followed by repair with 5.5-mm titanium suture anchors, 5.5-mm resorbable hydroxyapatite suture anchors, or transpatellar suture tunnels with No. 2 Ultrabraid and the Krackow whipstitch technique. Biomechanical analysis included pretensioning the constructs at 20 N for 30 seconds and then cyclic loading of 250 cycles between 20 and 100 N at 1 Hz in a servohydraulic testing machine with measurement of elongation. After this, ultimate failure load and failure mode analysis was performed.
Compared with transosseous sutures, tendon repairs with suture anchors yielded significantly less gap formation during cyclic loading (P < .05) and resisted significantly higher ultimate failure loads (P < .05). Common failure mode was pullout of the eyelet within the suture anchor in the hydroxyapatite anchor group and rupture of the suture in the titanium anchor group and-at lower load to failure-in the transosseous group.
Patellar tendon repair with suture anchors yields significantly better biomechanical results than repair with the commonly applied transosseous sutures.
These findings may be of relevance for future clinical treatment of patellar tendon ruptures. Randomized controlled clinical trials comparing suture anchors to transosseous suture repair are desirable.
髌腱断裂是需要手术修复的致残性损伤。目前尚缺乏关于最合适的缝合技术和缝合材料的可靠数据。标准手术方法是通过经髌隧道用缝线重新固定肌腱，有时还会结合加强术。
与经骨缝线修复相比，缝合锚钉在循环加载过程中的间隙形成和极限破坏载荷方面至少能产生相同的结果。
对照实验室研究。
对30条人尸体髌腱进行切断术，然后分别用5.5毫米钛制缝合锚钉、5.5毫米可吸收羟基磷灰石缝合锚钉或采用2号超强编织线和Krackow锁边缝合法的经髌缝线隧道进行修复。生物力学分析包括在20牛的力下对构建物预张紧30秒，然后在伺服液压试验机中以1赫兹的频率在20至100牛之间进行250次循环加载，并测量伸长量。在此之后，进行极限破坏载荷和破坏模式分析。
与经骨缝线相比，使用缝合锚钉修复肌腱在循环加载过程中产生的间隙明显更少（P < .05），并且能承受明显更高的极限破坏载荷（P < .05）。常见的破坏模式是羟基磷灰石锚钉组中缝合锚钉内的小孔拔出，钛锚钉组中缝线断裂，以及经骨组在较低的破坏载荷下出现缝线断裂。
与常用的经骨缝线修复相比，使用缝合锚钉修复髌腱产生的生物力学结果明显更好。
这些发现可能与未来髌腱断裂的临床治疗相关。需要进行比较缝合锚钉与经骨缝线修复的随机对照临床试验。
