Mayr Raul, Heinrichs Christian Heinz, Eichinger Martin, Smekal Vinzenz, Schmoelz Werner, Attal René
Department of Trauma Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
AUVA Trauma Center Klagenfurt, Waidmannsdorferstrasse 35, 9021, Klagenfurt, Austria.
Knee Surg Sports Traumatol Arthrosc. 2016 Sep;24(9):2983-2989. doi: 10.1007/s00167-015-3605-9. Epub 2015 Apr 19.
Performing all-inside anterior cruciate ligament reconstruction using cortical button fixation, the tendon graft has to be secured in a closed loop with sutures. In the present study, the graft secured with four sutures was compared with two reduced-suture material graft preparation techniques.
A bovine tendon graft folded over two adjustable-length loop cortical button devices was secured using the following techniques: 1, four buried-knot sutures; 2, two sutures on the tibial end only; and 3, two sutures on the tibial graft end with additional suspension on the tibial cortical button. Each group consisted of eight specimens and underwent cyclic loading followed by a load-to-failure test.
The least graft elongation after cyclic loading was observed for the graft with four sutures (6.1 ± 0.6 mm), followed by the graft with two sutures and additional suspension (6.3 ± 0.8 mm) and the graft with two sutures (7.0 ± 0.7 mm). The difference in graft elongation between four sutures and only two sutures was significant (P < 0.05). The ultimate failure loads were highest for the graft with two sutures and additional suspension (801 ± 107 N), followed by the graft with four sutures (766 ± 70 N), and the graft with two sutures (699 ± 87 N). No significant (n.s.) differences were observed between the ultimate failure loads in the three groups.
For the reduction in suture material to two sutures, additional suspension can be used in order to reduce the graft lengthening. Performing a suture-reducing graft can save operating time and costs. However, each of the three all-inside button graft techniques showed considerable graft elongation indicating a risk of graft lengthening in the early postoperative period.
采用皮质纽扣固定进行全关节镜下前交叉韧带重建时，肌腱移植物必须用缝线固定成闭环。在本研究中，将用四根缝线固定的移植物与两种减少缝线材料的移植物制备技术进行比较。
将牛肌腱移植物折叠在两个长度可调的环形皮质纽扣装置上，采用以下技术固定：1. 四根埋结缝线；2. 仅在胫骨端使用两根缝线；3. 在胫骨移植物端使用两根缝线，并在胫骨皮质纽扣上额外悬吊。每组由八个标本组成，先进行循环加载，然后进行破坏载荷试验。
循环加载后，四根缝线固定的移植物伸长最少（6.1±0.6毫米），其次是两根缝线并额外悬吊的移植物（6.3±0.8毫米）和两根缝线固定的移植物（7.0±0.7毫米）。四根缝线和仅两根缝线固定的移植物在伸长方面的差异具有统计学意义（P<0.05）。两根缝线并额外悬吊的移植物的极限破坏载荷最高（801±107牛顿），其次是四根缝线固定的移植物（766±70牛顿），两根缝线固定的移植物（699±87牛顿）。三组的极限破坏载荷之间未观察到显著差异（无统计学意义）。
为了将缝线材料减少到两根，可以使用额外悬吊以减少移植物延长。采用减少缝线的移植物可以节省手术时间和成本。然而，三种全关节镜纽扣移植物技术中的每一种都显示出相当大的移植物伸长，表明术后早期存在移植物延长的风险。
