Vestermark George, Hartigan David, Piasecki Dana, Fleischli James, Odum Susan M, Zheng Nigel, D'Alessandro Donald F
Orthopedics. 2017 Nov 1;40(6):e1009-e1016. doi: 10.3928/01477447-20170925-03. Epub 2017 Oct 3.
Biceps tenodesis maintains the cosmetic appearance and length-tension relationship of the biceps with an associated predictable clinical outcome compared with tenotomy. Arthroscopic suprapectoral techniques are being developed to avoid the disadvantages of the open subpectoral approach. This study biomechanically compared 3 arthroscopic suprapectoral biceps tenodesis techniques performed with a suture anchor with lasso loop technique, an interference screw, and a compressive rivet. For a total of 15 randomized paired tests, 15 pairs of human cadaveric shoulders were used to test 1 technique vs another 5 times with 3 customized setups. Biomechanical testing was performed with an electromechanical testing system. The tendon was preloaded with 10 N and cyclically loaded at 0 to 40 N for 50 cycles. Load to failure testing was performed at 1 mm/s until failure occurred. The compressive rivet, interference screw, and suture anchor with lasso loop had mean load to failure of 97.1 N, 146.4 N, and 157.6 N, respectively. The difference in ultimate strength between the suture anchor with lasso loop and the compressive rivet was statistically significant (P=.04). No significant differences were found between the suture anchor with lasso loop and the interference screw (P=.93) or between the interference screw and the rivet (P=.10). When adjusted for sex, the load to failure overall among the 3 constructs was not significantly different. All 3 techniques had a different predominant mechanism of failure. The suture anchor with lasso loop showed superior load to failure compared with the compressive rivet. The minimum load to failure required to achieve clinically reliable biceps tenodesis is unknown. [Orthopedics. 2017; 40(6):e1009-e1016.].
与肱二头肌切断术相比,肱二头肌固定术可保持肱二头肌的外观及长度 - 张力关系,并具有可预测的临床结果。关节镜下胸肌上技术正在不断发展,以避免开放胸肌下方法的缺点。本研究对3种使用缝线锚钉并结合套索环技术、干涉螺钉和加压铆钉的关节镜下胸肌上肱二头肌固定术进行了生物力学比较。总共进行15次随机配对测试,使用15对人类尸体肩部,通过3种定制设置对1种技术与另一种技术进行5次测试。使用机电测试系统进行生物力学测试。肌腱先预加载10 N,然后在0至40 N之间循环加载50次。以1 mm/s的速度进行直至失效的负载测试。加压铆钉、干涉螺钉和带套索环的缝线锚钉的平均失效负载分别为97.1 N、146.4 N和157.6 N。带套索环的缝线锚钉与加压铆钉之间的极限强度差异具有统计学意义(P = 0.04)。带套索环的缝线锚钉与干涉螺钉之间(P = 0.93)或干涉螺钉与铆钉之间(P = 0.10)未发现显著差异。在按性别调整后,3种结构的总体失效负载无显著差异。所有3种技术都有不同的主要失效机制。与加压铆钉相比,带套索环的缝线锚钉显示出更高的失效负载。实现临床可靠的肱二头肌固定术所需的最小失效负载尚不清楚。[《骨科学》。2017;40(6):e1009 - e1016。]