Steadman Philippon Research Institute, Vail, Colorado, USA.
The Steadman Clinic, Vail, Colorado, USA.
Am J Sports Med. 2018 Mar;46(4):801-808. doi: 10.1177/0363546517745626. Epub 2017 Dec 27.
Superior capsular reconstruction (SCR) was recently introduced as a treatment for irreparable superior rotator cuff tears in younger patients. Purpose/Hypothesis: The purpose was to assess the biomechanical strength of 3 methods for fixation of the graft to the glenoid for SCR. It was hypothesized that a 4-anchor technique would provide greater load to failure than 3-anchor techniques.
Controlled laboratory study.
Thirty-six cadaveric specimens were randomized into 3 groups of previously established glenoid-side graft fixation techniques: (1) three 3.5-mm knotless screw-in anchors, (2) three 3.0-mm knotless push-in anchors, and (3) a 4-anchor hybrid construct with two 3.0-mm knotted push-in anchors and two 2.9-mm knotless push-in anchors. The repairs were cyclically loaded at 0.5 Hz from 10 to 200 N, then pulled to failure. Elongation, stiffness, maximum load at failure, and mode of failure were recorded and calculated.
There were no significant differences in graft elongation or stiffness among the 3 techniques ( P > .37 and P > .26, respectively). Maximum load to failure was significantly greater in technique 1 (mean ± SD, 427.85 ± 119.70 N) than technique 3 (319.5 ± 57.60 N) ( P = 0.024). There were no significant differences in load to failure between techniques 1 and 2 or between techniques 2 and 3.
Glenoid-side graft fixation with 3 threaded 3.5-mm suture anchors showed a significant superior pull-out strength when compared with a 4-anchor hybrid technique and thus might be recommended in SCR for patients with irreparable superior rotator cuff tears to achieve maximum stability.
SCR presents a novel alternative for treatment of irreparable superior rotator cuff tears in younger patients. Glenoid fixation is essential to provide adequate fixation of the graft to prevent the humeral head from rising and to restore normal biomechanics.
Superior capsular reconstruction（SCR）最近被引入作为治疗年轻患者不可修复的上肩袖撕裂的一种方法。目的/假设：目的是评估 SCR 中用于固定移植物到关节盂的 3 种方法的生物力学强度。假设 4 锚技术比 3 锚技术提供更大的失效负载。
对照实验室研究。
将 36 个尸体标本随机分为 3 组，以前建立的关节盂侧移植物固定技术：（1）三个 3.5mm 无结螺纹植入式锚钉，（2）三个 3.0mm 无结推入式锚钉，和（3）一个 4 锚混合结构，其中两个 3.0mm 带结推入式锚钉和两个 2.9mm 无结推入式锚钉。修复物以 0.5Hz 的频率从 10N 循环加载到 200N，然后拉至失效。记录和计算伸长率、刚度、失效时的最大载荷和失效模式。
三种技术之间的移植物伸长率或刚度没有显著差异（P >.37 和 P >.26，分别）。技术 1（平均±SD，427.85±119.70N）的失效时最大载荷明显大于技术 3（319.5±57.60N）（P = 0.024）。技术 1 和 2 之间以及技术 2 和 3 之间的失效时载荷没有显著差异。
与 4 锚混合技术相比，关节盂侧移植物固定使用 3 个带螺纹的 3.5mm 缝线锚钉显示出显著的拔出强度优势，因此可能建议在 SCR 中用于治疗不可修复的上肩袖撕裂的患者，以获得最大的稳定性。
SCR 为年轻患者不可修复的上肩袖撕裂提供了一种新的治疗选择。关节盂固定对于提供足够的移植物固定至关重要，以防止肱骨头抬起并恢复正常的生物力学。
