Denard Patrick J, Adams Christopher R, Fischer Nicole C, Piepenbrink Marina, Wijdicks Coen A
Southern Oregon Orthopedics, Medford, Oregon, USA.
Naples Community Hospital Healthcare System, Naples, Florida, USA.
Orthop J Sports Med. 2018 May 21;6(5):2325967118774000. doi: 10.1177/2325967118774000. eCollection 2018 May.
Historically, tendon-to-bone fixation has relied on knot tying. However, considerable variability exists in knot-tying strength among surgeons.
PURPOSE/HYPOTHESIS: The purpose of this study was to compare the biomechanical properties of knotted and knotless fixation and to evaluate variability among surgeons. The hypothesis was that knotless constructs would be stronger and have less variability as compared with knotted constructs.
Controlled laboratory study.
A total of 34 orthopaedic surgeons participated in a laboratory study to compare knotted and knotless constructs, where 104 knotted constructs were performed with No. 2 suture, 21 knotless constructs with No. 2 suture (K2 group), and 79 knotless constructs with suture tape (KT group). Mechanical testing was performed to compare load at 3 mm of displacement, load to failure, and stiffness of each construct.
The mean load at 3 mm of displacement was greatest in the KT group, with significant differences among all 3 groups ( < .001). Load to failure was significantly greater in the KT group as compared with the K2 group and the knotted group ( < .001), but there was no difference between the K2 and knotted groups ( ≥ .999). Stiffness and displacement were also greatest in the KT group. Based on the test, the variance in load to failure was significantly different between the knotted and knotless constructs, with the knotted group demonstrating greater variability (SD, 94 N) than the KT (SD, 38 N) and K2 (SD, 17 N) groups ( < .001).
Knotless fixation with suture tape had improved biomechanical performance as compared with knots or knotless fixation with No. 2 suture. In addition, knotless fixation had less variability in biomechanical properties among multiple surgeons.
This study may be relevant for surgeons choosing between knotted and knotless constructs as well as for considerations in the design of rotator cuff repair constructs.
从历史上看，肌腱与骨的固定依赖于打结。然而，外科医生之间打结强度存在相当大的差异。
目的/假设：本研究的目的是比较打结固定和无结固定的生物力学特性，并评估外科医生之间的差异。假设是与打结结构相比，无结结构更强且变异性更小。
对照实验室研究。
共有34名骨科医生参与了一项实验室研究，以比较打结和无结结构，其中用2号缝线进行了104个打结结构，用2号缝线进行了21个无结结构（K2组），用缝线带进行了79个无结结构（KT组）。进行力学测试以比较每个结构在3毫米位移时的负荷、破坏负荷和刚度。
KT组在3毫米位移时的平均负荷最大，所有3组之间存在显著差异（P <.001）。与K2组和打结组相比，KT组的破坏负荷显著更大（P <.001），但K2组和打结组之间没有差异（P ≥.999）。KT组的刚度和位移也最大。基于F检验，打结和无结结构之间的破坏负荷方差显著不同，打结组的变异性（标准差，94 N）大于KT组（标准差，38 N）和K2组（标准差，17 N）（P <.001）。
与打结或用2号缝线的无结固定相比，用缝线带的无结固定具有更好的生物力学性能。此外，无结固定在多个外科医生之间的生物力学特性变异性更小。
本研究可能与外科医生在打结和无结结构之间的选择以及肩袖修复结构设计的考虑有关。
