Hyatt Adam E, Lavery Kyle, Mino Christopher, Dhawan Aman
Department of Orthopaedic Surgery, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, U.S.A..
Department of Orthopaedic Surgery, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey, U.S.A.
Arthroscopy. 2016 Apr;32(4):544-50. doi: 10.1016/j.arthro.2015.08.034. Epub 2015 Oct 30.
To identify the biomechanical consequences of violating the cortical shelf when preparing the greater tuberosity for suture anchor repair.
Demographic information and bone mineral density were obtained for 20 fresh-frozen human humeri (10 matched pairs). Suture anchors were placed at a predetermined location in decorticated and non-decorticated settings after randomization. Anchors were tested under cyclic loads followed by load-to-failure testing. The number of cycles, failure mode, stiffness, and final pullout strength were recorded.
Nineteen specimens met the inclusion criteria for final testing. A significant difference in mean ultimate load to failure was seen between the non-decorticated specimens (244.04 ± 89.06 N/mm) and the decorticated humeri (62.84 ± 38.04 N/mm, P < .0001). Regression analysis showed positive correlations with female gender and decreased bone mineral density (P = .008 and P = .0005, respectively).
Decortication of the rotator cuff footprint significantly decreases the pullout strength of the suture anchor. Gender and bone mineral density also play a significant role in bone-anchor biomechanics and should be considered during repair.
Caution should be exercised when preparing the rotator cuff footprint before suture anchor placement because of the significant risk of early repair failure at the bone-anchor interface.
确定在准备大结节以进行缝线锚钉修复时破坏皮质骨板的生物力学后果。
获取20具新鲜冷冻人肱骨（10对匹配样本）的人口统计学信息和骨密度。随机分组后，在去皮质和未去皮质的情况下将缝线锚钉置于预定位置。对锚钉进行循环加载测试，随后进行破坏载荷测试。记录循环次数、破坏模式、刚度和最终拔出强度。
19个样本符合最终测试的纳入标准。未去皮质样本（244.04±89.06 N/mm）和去皮质肱骨样本（62.84±38.04 N/mm，P<.0001）之间的平均破坏极限载荷存在显著差异。回归分析显示与女性性别和骨密度降低呈正相关（分别为P=.008和P=.0005）。
肩袖足迹区去皮质显著降低缝线锚钉的拔出强度。性别和骨密度在骨-锚钉生物力学中也起重要作用，在修复过程中应予以考虑。
在放置缝线锚钉前准备肩袖足迹区时应谨慎，因为骨-锚钉界面早期修复失败的风险很大。
