Jin Cheng, Paluvadi Siddhartha Venkata, Lee SungJae, Yoo SeungJin, Song Eun-Kyoo, Seon Jong-Keun
Center for Joint Diseases, Chonnam National Univerity Bitgoeul Hospital, Chonnam National University School of Medicine, 160 Ilsimri, Hwasun-eup, Hwaun-gun, 519-809, Hwasun, Jeolla-Namdo, South Korea.
The Department of Orthopaedic Surgery, Peoples' College of Medical Sciences and Research Center, Bhopal, India.
Int Orthop. 2018 Jun;42(6):1291-1296. doi: 10.1007/s00264-018-3780-7. Epub 2018 Jan 29.
Cortical suspensory devices are routinely used for femoral side fixation of soft tissue graft in anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to evaluate the biomechanical properties of a new adjustable loop device (GraftMax®) compared with established devices (EndoButton® and TightRope®) in ACL reconstruction and to investigate whether knotting the free end of TightRope could improve biomechanical properties.
The three cortical suspensory devices (GraftMax® Button; Conmed, EndoButton® CL; Smith & Nephew, and TightRope® RT; Arthrex) were tested under cyclic load (50-250 N for 1000 cycles) and pull-to-failure conditions at 50 mm/h in a device-only setup using a tensile testing machine. The TightRope was additionally tested with its free suture ends knotted. The statistical analyses were done with one-way analysis of variance (ANOVA) and post hoc Tukey HSD tests.
There are significant differences in the load-to-failure among the devices. The EndoButton showed the highest mean failure load at 1204.7 N compared to other devices (GraftMax (914.2 N), knotted TightRope (868.1 N) and TightRope (800.1 N) (p < 0.001). The mean total displacement after 1000 cycles was 0.76 mm, 2.11 mm, 1.56 mm and 1.38 mm for the EndoButton, GraftMax, TightRope, and knotted TightRope, respectively. The EndoButton showed significantly better properties than both the GraftMax (p = 0.000) and the TightRope (p = 0.020) but not the knotted TightRope (p = n.s.) in total displacement. However, there was no significant difference between the TightRope and GraftMax (p = n.s.).
The fixed loop (EndoButton) showed significantly better mechanical properties in failure load and displacement than TightRope or GraftMax in this biomechanical study. However, the mechanical properties of the GraftMax is comparable to the TightRope. Moreover, the knotting of TightRope improved mechanical properties in total displacement more than TightRope, but not in failure load.
The biomechanical properties of the GraftMax are comparable to the TightRope. The TightRope, when knotted, shows an improvement both in load to failure and cyclic displacement, though the differences are not significant.
在膝关节前交叉韧带（ACL）重建术中，皮质悬吊装置常用于软组织移植物的股骨侧固定。本研究的目的是评估一种新型可调环装置（GraftMax®）与已有的装置（EndoButton®和TightRope®）在ACL重建中的生物力学性能，并研究TightRope游离端打结是否能改善生物力学性能。
使用拉伸试验机，在仅装置的设置下，对三种皮质悬吊装置（GraftMax®纽扣；康美公司，EndoButton® CL；施乐辉公司，以及TightRope® RT；捷迈邦美公司）进行循环加载（50 - 250 N，1000次循环）和以50 mm/h的速度进行拉断试验。TightRope还对其游离缝线端打结后进行了测试。采用单因素方差分析（ANOVA）和事后Tukey HSD检验进行统计分析。
各装置之间的破坏载荷存在显著差异。与其他装置相比，EndoButton的平均破坏载荷最高，为1204.7 N（GraftMax为914.2 N，打结的TightRope为868.1 N，TightRope为800.1 N）（p < 0.001）。EndoButton、GraftMax、TightRope和打结的TightRope在1000次循环后的平均总位移分别为0.76 mm、2.11 mm、1.56 mm和1.38 mm。在总位移方面,EndoButton的性能明显优于GraftMax（p = 0.000）和TightRope（p = 0.020），但与打结的TightRope相比无显著差异（p = 无统计学意义）。然而，TightRope和GraftMax之间无显著差异（p = 无统计学意义）。
在本生物力学研究中，固定环（EndoButton）在破坏载荷和位移方面的力学性能明显优于TightRope或GraftMax。然而，GraftMax的力学性能与TightRope相当。此外，TightRope打结在总位移方面比未打结的TightRope改善了力学性能，但在破坏载荷方面没有改善。
GraftMax的生物力学性能与TightRope相当。TightRope打结后，在破坏载荷和循环位移方面均有改善，尽管差异不显著。
