Métais Pierre, Lanzone Roberto, Lim Chauncey Kester, Albino Paolo, Carbone Stefano
Clinique La Châtaigneraie, Beaumont, Clermont-Ferrand, France.
Department of Orthopaedic and Traumatology, Sapienza University of Rome, Rome, Italy.
Arthrosc Tech. 2015 Sep 21;4(5):e457-61. doi: 10.1016/j.eats.2015.04.004. eCollection 2015 Oct.
The principle of margin convergence can be applied to rotator cuff repair to enhance the security of fixation by decreasing the mechanical strain at the margins of the tear. We describe a suture technique, over-under lacing, that reproduces the same margin convergence, with equal tissue tension across the entire surface area of the cuff. A consecutive series of patients affected by massive U-shaped rotator cuff tears were treated by this repair technique. Preoperative diagnosis, tear assessment, and grading of fatty infiltration of the cuff muscles were based on arthro-computed tomography evaluation. The technique passes 2 sutures from the medial to lateral margin of the tear, with a knotless suture anchor for tendon-to-bone fixation. The proposed technique seems to reduce tensile strain on the repaired tendon, can reconstruct the rotator cuff cable, and can attain the balanced pull of the tendon in a medial-to-lateral fashion. The over-under lacing suture technique is both simple and reproducible. This technique may achieve the goals of margin convergence with satisfactory preliminary clinical results for patients with massive rotator cuff tears.
边缘汇聚原理可应用于肩袖修复，通过减少撕裂边缘的机械应变来提高固定的安全性。我们描述了一种缝合技术——上下交叉缝合，该技术可实现相同的边缘汇聚，且在肩袖的整个表面积上具有相等的组织张力。连续一系列患有巨大U形肩袖撕裂的患者接受了这种修复技术治疗。术前诊断、撕裂评估以及肩袖肌肉脂肪浸润分级均基于关节计算机断层扫描评估。该技术从撕裂的内侧边缘到外侧边缘穿过2根缝线，使用无结缝线锚钉进行肌腱到骨的固定。所提出的技术似乎可以减少修复肌腱上的拉伸应变，能够重建肩袖缆线，并能以从内侧到外侧的方式实现肌腱的平衡牵拉。上下交叉缝合技术既简单又可重复。对于患有巨大肩袖撕裂的患者，该技术可能实现边缘汇聚的目标，并取得令人满意的初步临床效果。
