Department of Sports Medicine and Arthroscopy Surgery, Sports Medicine Center of Fudan University, Huashan Hospital, Shanghai, China.
Arthroscopy. 2013 Nov;29(11):1817-25. doi: 10.1016/j.arthro.2013.08.015.
The purpose of this study was to compare the biomechanical characteristics of fixation with 2-suture anchors versus transosseous tunnel fixation in anatomic reconstruction of the ankle lateral ligaments.
Six matched pairs of human cadaveric ankles underwent anatomic lateral ankle reconstruction, and fixation of the graft on the talus was achieved with 2 suture anchors or a transosseous tunnel. Ankles for the transosseous tunnel group were chosen at random, with the paired contralateral ankles used for the 2-suture anchor group. Half of the peroneus brevis tendon was harvested as a graft. For each technique, one end of the tendon was secured to the original insertion point of the anterior talofibular ligament (ATFL) at the talus, whereas the other end was armed with 2 No. 5 nonabsorbable sutures (Ethicon, Somerville, NJ) and passed through the bone tunnel in the fibula. Biomechanical testing was performed by applying the force in line with the graft. Load to failure was determined at a displacement rate of 50 mm/min. The load-displacement curve, maximum load at failure (N), and stiffness (N/mm) were recorded and compared between the 2 techniques.
There was no difference between constructs in the 2-suture anchor group and the transosseous tunnel group in terms of the ultimate load and stiffness (161.8 ± 47.6 N v 171.9 ± 76.0 N; P = .92; 4.59 ± 1.85 N/mm v 5.77 ± 1.98 N/mm; P = .35). Most constructs failed because of anchor pullout in the 2-suture anchor group (5 of 6) and fracture of the bony bridge in the transosseous tunnel group (6 of 6).
The strength of fixation with suture anchors in anatomic reconstruction of the ankle lateral ligaments was equivalent to transosseous tunnel fixation as determined with biomechanical testing. However, this study did not prove that one is advantageous over the other.
Both techniques showed excellent biomechanical results. Therefore, the 2-suture anchor fixation approach can be safely used in anatomic reconstruction of the ankle lateral ligaments.
本研究旨在比较使用 2 个缝线锚钉与经皮骨隧道固定在解剖重建踝关节外侧韧带中的生物力学特性。
6 对匹配的人尸体踝关节行解剖外侧踝关节重建，将移植物固定在距骨上，使用 2 个缝线锚钉或经皮骨隧道固定。经皮骨隧道组的踝关节随机选择，配对的对侧踝关节用于 2 个缝线锚钉组。腓骨短肌腱的一半被用作移植物。对于每种技术，肌腱的一端固定在距骨的前距腓韧带（ATFL）的原始插入点，而另一端用 2 根 No. 5 不可吸收缝线（Ethicon，Somerville，NJ）武装，并穿过腓骨中的骨隧道。生物力学测试通过沿移植物施加力进行。以 50mm/min 的位移速率确定失效时的负载。记录和比较 2 种技术之间的负载-位移曲线、失效时的最大负载（N）和刚度（N/mm）。
在 2 个缝线锚钉组和经皮骨隧道组中，在最终负载和刚度方面，两种结构之间没有差异（161.8 ± 47.6N 比 171.9 ± 76.0N；P=.92；4.59 ± 1.85N/mm 比 5.77 ± 1.98N/mm；P=.35）。在 2 个缝线锚钉组中，大多数结构因锚钉拔出而失效（6 个中的 5 个），在经皮骨隧道组中，因骨桥断裂而失效（6 个中的 6 个）。
生物力学测试表明，在解剖重建踝关节外侧韧带中，缝线锚钉固定的强度与经皮骨隧道固定相当。然而，本研究并未证明一种方法优于另一种方法。
两种技术均显示出出色的生物力学结果。因此，2 个缝线锚钉固定方法可安全用于解剖重建踝关节外侧韧带。
