Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut, Farmington, Connecticut, USA.
Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.
Am J Sports Med. 2019 Aug;47(10):2478-2483. doi: 10.1177/0363546519860489. Epub 2019 Jul 19.
A rupture of the distal biceps tendon is the most common tendon rupture of the elbow and has received increased attention in the past few years. Newly developed all-suture anchors have the potential to minimize surgical trauma and the risk of adverse events because of the use of flexible drills and smaller drill diameters.
PURPOSE/HYPOTHESIS: The purpose was to biomechanically compare all-suture anchors and titanium suture anchors for distal biceps tendon repair in cadaveric specimens. The hypothesis was that all-suture anchors would show no differences in load to failure or displacement under cyclic loading compared with titanium suture anchors.
Controlled laboratory study.
Sixteen unpaired, fresh-frozen human cadaveric elbows were randomized to 2 groups, which underwent onlay distal biceps tendon repair with 2 anchors. Bone mineral density at the radial tuberosity was evaluated in each specimen. In the first group, distal biceps tendon repair was performed using all-suture anchors. In the second group, titanium suture anchors were applied. After cyclic loading for 3000 cycles, the repair constructs were loaded to failure. The peak load to failure as well as repair construct stiffness and mode of failure were determined.
The mean (±SD) peak load was 293.53 ± 122.15 N for all-suture anchors and 280.02 ± 69.34 N for titanium suture anchors ( = .834); mean stiffness was 19.78 ± 2.95 N/mm and 19.30 ± 4.98 N/mm, respectively ( = .834). The mode of failure was anchor pullout for all specimens during load to failure. At the proximal position, all-suture anchors showed a displacement of 1.53 ± 0.80 mm, and titanium suture anchors showed a displacement of 0.81 ± 0.50 mm ( = .021) under cyclic loading. At the distal position, a displacement of 1.86 ± 1.04 mm for all-suture anchors and 1.53 ± 1.15 mm for titanium suture anchors was measured ( = .345). A positive correlation between bone mineral density and load to failure was observed ( = 0.605; = .013).
All-suture anchors were biomechanically equivalent at time zero to titanium suture anchors for onlay distal biceps tendon repair. While the proximally placed all-suture anchors demonstrated greater displacement than titanium suture anchors, the comparable displacement at the distal position as well as the similar load and mechanism of failure make this difference unlikely to be clinically significant.
All-suture anchors performed similarly to titanium suture anchors for onlay distal biceps tendon repair at time zero and represent a reasonable alternative.
远端肱二头肌肌腱断裂是肘部最常见的肌腱断裂，近年来受到了更多的关注。新型全缝线锚钉的使用灵活的钻头和更小的钻头直径，有可能最大限度地减少手术创伤和不良事件的风险。
目的/假设：本研究旨在对尸体标本进行生物力学比较，研究全缝线锚钉和钛缝线锚钉修复远端肱二头肌肌腱的效果。假设全缝线锚钉在失效负荷和循环加载下的位移与钛缝线锚钉无差异。
对照实验室研究。
将 16 个未配对的新鲜冷冻人尸体肘部随机分为 2 组，每组进行外侧远端肱二头肌肌腱修复，使用 2 个锚钉。对每个标本的桡骨粗隆的骨密度进行评估。在第 1 组中，使用全缝线锚钉进行远端肱二头肌肌腱修复。在第 2 组中，应用钛缝线锚钉。经过 3000 次循环加载后，对修复结构进行失效负荷测试。确定失效负荷时的峰值负荷、修复结构的刚度和失效模式。
全缝线锚钉的平均（±SD）峰值负荷为 293.53±122.15N，钛缝线锚钉的平均峰值负荷为 280.02±69.34N（ =.834）；平均刚度分别为 19.78±2.95N/mm 和 19.30±4.98N/mm（ =.834）。在失效负荷测试中，所有标本的失效模式均为锚钉拔出。在近端位置，全缝线锚钉的位移为 1.53±0.80mm，钛缝线锚钉的位移为 0.81±0.50mm（ =.021）。在远端位置，全缝线锚钉的位移为 1.86±1.04mm，钛缝线锚钉的位移为 1.53±1.15mm（ =.345）。骨密度与失效负荷呈正相关（ = 0.605； =.013）。
在外侧远端肱二头肌肌腱修复中，全缝线锚钉在初始时与钛缝线锚钉具有相同的生物力学性能。虽然近端放置的全缝线锚钉的位移大于钛缝线锚钉，但在远端位置的相似位移以及相似的负荷和失效机制使这种差异不太可能具有临床意义。
全缝线锚钉在初始时与钛缝线锚钉一样可用于外侧远端肱二头肌肌腱修复，是一种合理的替代选择。
