Center for Musculoskeletal Surgery, Charitè Universitaetsmedizin Berlin, Berlin, Germany; Steadman Philippon Research Institute, Vail, Colorado, U.S.A.; Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany.
Steadman Philippon Research Institute, Vail, Colorado, U.S.A.
Arthroscopy. 2020 Jun;36(6):1523-1532. doi: 10.1016/j.arthro.2020.01.046. Epub 2020 Feb 10.
To evaluate the biomechanical performance of Bankart repair using 1.8-mm knotless all-suture anchors in comparison to 1.8-mm knotted all-suture anchors with both simple and horizontal mattress stitch configurations.
Thirty fresh-frozen human cadaveric shoulders were dissected to the capsule, leaving the glenoid and humeral capsular insertions intact. A standardized anteroinferior labral tear was created and repaired using 3 anchors. A 2 × 2 factorial design was implemented, with 6 matched pairs randomized between knotless and knotted anchor repairs and 6 matched pairs randomized into simple and horizontal mattress stitch configurations. In addition, 6 unpaired shoulders were used to evaluate the native capsulolabral state. First failure load, ultimate load, and stiffness were assessed. Linear mixed-effects modeling was used to compare endpoints. Digital image correlation was used to evaluate capsular strain throughout testing. Failure modes were reported qualitatively.
The knotless all-suture anchor repair showed similar biomechanical strength to the knotted all-suture anchors for first failure load (coefficient, 142 N; 95% confidence interval [CI], -30 to 314 N; P = .12), ultimate load (coefficient, 11.1 N; 95% CI, -104.9 to 127.2 N; P = .847), and stiffness (coefficient, 3.4 N/mm; 95% CI, -14.1 to 20.9 N/mm; P = .697) when stitch configuration was held constant. No statistically significant differences were found on comparison of simple and mattress stitch configurations for first failure load (coefficient, -31 N; 95% CI, -205 to 143 N; P = .720), ultimate load (coefficient, 112 N; 95% CI, -321 to 97 N; P = .291), and stiffness (coefficient, -9.6 N/mm; 95% CI, -27.3 to 8.1 N/mm; P = .284) when anchor type was held constant. Specimens with knotless anchors and simple stitch techniques resulted in lower stiffness compared with the native state (P = .030). The knotless-mattress configuration resulted in significantly lower strain than the knotted-mattress (P = .037) and knotless-simple (P = .019) configurations and was the only configuration that did not result in a significant increase in strain compared with the intact specimens (P = .216). Fewer instances of suture slippage (loss of loop security) were observed with knotless anchors versus knotted anchors (11% vs 30%), and less soft-tissue failure was observed with the mattress stitch configuration versus the simple stitch configuration (36% vs 47%).
Knotless and knotted all-suture anchor repairs with simple and mattress stitch configurations showed similar values of ultimate load, first failure load, and stiffness. However, the horizontal mattress stitch configuration proved to decrease capsular strain more similarly to the native state compared with the simple stitch configuration. Ultimate load and first failure load for all repairs were similar to those of the native state.
Knotless all-suture anchors have a smaller diameter than solid anchors, can be inserted through curved guides, and preserve glenoid bone stock. This study presents knotless, tensionable all-suture anchor repair for labral tears that displays high biomechanical fixation strength, similar to the native capsulolabral state.
评估 Bankart 修复中使用 1.8mm 无结全缝线锚钉与 1.8mm 有结全缝线锚钉的生物力学性能，缝线配置为简单和水平褥式缝合。
30 个新鲜冷冻的人尸体肩关节被解剖到关节囊，保留盂肱关节囊的附着。采用标准化的前下盂唇撕裂模型，使用 3 个锚钉进行修复。采用 2×2 析因设计，6 对匹配的标本随机分为无结和有结锚钉修复，6 对匹配的标本随机分为简单和水平褥式缝合配置。此外，还使用 6 个非配对的肩关节来评估原生的关节囊盂唇状态。评估首次失效负荷、极限负荷和刚度。采用线性混合效应模型比较终点。数字图像相关用于评估整个测试过程中的关节囊应变。报告失效模式定性。
当缝线配置保持不变时，无结全缝线锚钉修复的首次失效负荷（系数，142N；95%置信区间 [CI]，-30 至 314N；P=.12）、极限负荷（系数，11.1N；95%CI，-104.9 至 127.2N；P=.847）和刚度（系数，3.4N/mm；95%CI，-14.1 至 20.9N/mm；P=.697）与有结全缝线锚钉相似。当锚钉类型保持不变时，比较简单和褥式缝线配置，首次失效负荷（系数，-31N；95%CI，-205 至 143N；P=.720）、极限负荷（系数，112N；95%CI，-321 至 97N；P=.291）和刚度（系数，-9.6N/mm；95%CI，-27.3 至 8.1N/mm；P=.284）无统计学差异。与原生状态相比，使用无结锚钉和简单缝线技术的标本刚度较低（P=.030）。无结褥式配置的应变显著低于有结褥式（P=.037）和无结简单式（P=.019）配置，与完整标本相比，无结褥式配置不会导致应变显著增加（P=.216）。与有结锚钉相比，无结锚钉的缝线滑脱（缝线环安全性丧失）较少（11% vs 30%），而褥式缝线配置的软组织失败较简单缝线配置（36% vs 47%）少。
使用简单和褥式缝线配置的无结和有结全缝线锚钉修复具有相似的极限负荷、首次失效负荷和刚度值。然而，与简单缝线配置相比，水平褥式缝线配置可更相似地降低关节囊的应变，更接近原生状态。所有修复的极限负荷和首次失效负荷均与原生状态相似。
无结全缝线锚钉的直径小于实心锚钉，可通过弯曲的导针插入，且保留盂唇骨的完整性。本研究介绍了用于盂唇撕裂的无结、可张紧的全缝线锚钉修复，具有较高的生物力学固定强度，与原生的关节囊盂唇状态相似。
