Plano Orthopedic Sports Medicine Center, Plano, Texas, U.S.A.
DePuy Mitek Sports Medicine, Raynham, Massachusetts, U.S.A.; Rensselaer Polytechnic Institute, Troy, New York, U.S.A.
Arthroscopy. 2019 Apr;35(4):1163-1169. doi: 10.1016/j.arthro.2018.10.140. Epub 2019 Mar 11.
The purpose of this study was to compare 6 different graft fixation techniques to determine the preparation speed, fixation security, biomechanical strength, and resultant tissue trauma.
Six different techniques (10 samples each): #2 OrthoCord Krackow stitch, #2 FiberWire Krackow stitch, SpeedTrap, WhipKnot, Loop-in-loop stitch were created in the distal 3 cm of 9 cm bovine flexor tendons. The proximal 3 cm tendon segment was clamped in a testing machine and the distal suture ends secured by pneumatic grips. 3 preload cycles (10N-100N) and 50N static load was followed by 500 cycles (50N-200N) and then loaded to failure. Graft preparation times, 100 and 500 cycle displacement, maximum failure load, stiffness, and failure mode were recorded.
Representative graft preparation times were: OrthoCord Krackow (247s), FiberWire Krackow (401s), FiberLoop (177s), SpeedTrap (42s), WhipKnot (39s), Loop-in-loop (45s). No WhipKnots survived cyclic loading. 100 cycle displacements were: OrthoCord Krackow (11.5 ± 3.9 mm), FiberWire Krackow (8.9 ± 1.2 mm), FiberLoop (14.2 ± 6.1 mm), SpeedTrap (8.8 ± 2.5 mm), Loop-in-loop (10.4 ± 2.9 mm). FiberLoop displaced significantly more than all others (P = .016). Maximum failure loads were: OrthoCord Krackow (364 ± 24N), FiberWire Krackow (375 ± 45N), FiberLoop (413 ± 95N), SpeedTrap (437 ± 65N), WhipKnot (153 ± 42N), Loop-in-loop (329 ± 112N). The most common failure mode was suture breaking. FiberWire containing constructs (Krackow and FiberLoop) shredded or cut through ("cheese wiring") prior to failure in a majority.
SpeedTrap, WhipKnot and Loop-in-loop were quickest to create (under 1 minute). The Krackow, SpeedTrap, WhipKnot, and Loop-in-Loop did not damage the tendon during cyclic loading. SpeedTrap and Krackow had the least displacement. FiberLoop displaced more than all other groups (P = .016). No WhipKnot completed cyclic loading. The SpeedTrap (437N) and FiberLoop (413N) had the highest ultimate strength.
While the SpeedTrap and FiberLoop are the strongest techniques, the FiberLoop shreds the tendon, displaced the most, and took longer to create. Based on these results, the SpeedTrap demonstrates the best overall performance.
本研究旨在比较 6 种不同的移植物固定技术，以确定准备速度、固定安全性、生物力学强度和组织创伤。
在 9cm 牛屈肌腱的远端 3cm 处创建 6 种不同的技术（每组 10 个样本）：#2 OrthoCord Krackow 缝线、#2 FiberWire Krackow 缝线、SpeedTrap、WhipKnot、Loop-in-loop 缝线。近端 3cm 的肌腱段夹在试验机中，远端缝线末端用气动夹具固定。进行 3 个预载循环（10N-100N）和 50N 静载，然后进行 500 个循环（50N-200N），然后加载至失效。记录移植物准备时间、100 次和 500 次循环位移、最大失效载荷、刚度和失效模式。
代表性的移植物准备时间如下：OrthoCord Krackow（247s）、FiberWire Krackow（401s）、FiberLoop（177s）、SpeedTrap（42s）、WhipKnot（39s）、Loop-in-loop（45s）。没有 WhipKnot 能承受循环载荷。100 次循环位移分别为：OrthoCord Krackow（11.5 ± 3.9mm）、FiberWire Krackow（8.9 ± 1.2mm）、FiberLoop（14.2 ± 6.1mm）、SpeedTrap（8.8 ± 2.5mm）、Loop-in-loop（10.4 ± 2.9mm）。FiberLoop 的位移明显大于其他所有组（P =.016）。最大失效载荷分别为：OrthoCord Krackow（364 ± 24N）、FiberWire Krackow（375 ± 45N）、FiberLoop（413 ± 95N）、SpeedTrap（437 ± 65N）、WhipKnot（153 ± 42N）、Loop-in-loop（329 ± 112N）。最常见的失效模式是缝线断裂。含纤维丝的构建物（Krackow 和 FiberLoop）在失效前大部分出现撕裂或切断（“奶酪布线”）。
SpeedTrap、WhipKnot 和 Loop-in-loop 是最快创建的（不到 1 分钟）。Krackow、SpeedTrap、WhipKnot 和 Loop-in-Loop 在循环加载过程中不会对肌腱造成损伤。SpeedTrap 和 Krackow 的位移最小。FiberLoop 的位移大于其他所有组（P =.016）。没有 WhipKnot 能完成循环加载。SpeedTrap（437N）和 FiberLoop（413N）的最终强度最高。
虽然 SpeedTrap 和 FiberLoop 是最强的技术，但 FiberLoop 会撕裂肌腱，位移最大，且创建时间更长。基于这些结果，SpeedTrap 表现出了最佳的整体性能。
