无结锚钉在预防半月板移位方面比有结锚钉效果更好：一项针对牛膝关节的实验研究。
Knotless anchors offer better prevention of meniscal excursion than knotted anchors: An experimental study of the bovine knee.
作者信息
Eren Mehmet Burtaç, Aşçı Murat, Tönük Ergin, Balta Orhan, Kurnaz Recep
机构信息
Department of Orthopaedics and Traumatology, Tokat Gaziosmanpaşa University, School of Medicine, Tokat, Turkey.
Department of Orthopaedics and Traumatology, Eskişehir Acıbadem Hospital, Eskişehir, Turkey.
出版信息
Acta Orthop Traumatol Turc. 2020 Jan;54(1):97-103. doi: 10.5152/j.aott.2020.01.439.
OBJECTIVE
Due to the biomechanical importance of the meniscal root ligament, several surgical techniques have been defined in order to treat meniscal root tear. Different application techniques have different levels of difficulty. We aimed to find a stronger and simpler repair technique.
METHODS
Sixteen bovine knee joints were prepared. The posterior root of the medial meniscus was dissected and repaired with one of two different techniques. The knees in group 1 ("knotted group") were repaired with the knotted suture anchor technique, and the knees in group 2 ("knotless group") were repaired using the knotless suture anchor technique. The strength of the repairs was tested biomechanically.
RESULTS
Cyclic loading tests were done. On the 0-20 N one-cycle test, the knotted anchor group's equivalent stiffness average was 5.28 N/mm, and the knotless anchor group's equivalent stiffness average was 5.48 N/mm. The 5-20 N two-cycle test results were 8.29 N/mm for the knotted group and 8.66 N/mm for the knotless group. On the 5-20 N 100-cycle test, the equivalent stiffness averages were 8.59 N/mm for the knotted group and 10.18 N/mm for the knotless group. Elongation was 5.83 mm for the knotted group and 4.86 mm for the knotless group. After performing load-to-failure tests, the failure forces were recorded as 237.83 N for the knotted group and 204.90 N for the knotless group. The failure test elongation values were 26.83 mm for the knotted group and 18.70 mm for the knotless group. The failure energies were 3.87 J for the knotted group and 1.83 J for the knotless group. Except for elongation until failure (p=0.009), there were no significant differences between the two groups tested (p>0.05). The average elongation was significantly less in group 2, showing that the knotless anchor had an advantage, with less meniscal excursion compared to the sutured anchor.
CONCLUSION
Knotless anchors have a mechanical advantage over knotted anchors for preventing meniscal excursion. When thought together with technical simplicity during arthroscopic surgery, knotless anchors could be used safely for the fixation of the meniscal root ligament.
目的
由于半月板根部韧带的生物力学重要性，已定义了多种手术技术来治疗半月板根部撕裂。不同的应用技术具有不同的难度级别。我们旨在找到一种更强且更简单的修复技术。
方法
准备16个牛膝关节。解剖内侧半月板后根，并用两种不同技术之一进行修复。第1组（“打结组”）的膝关节采用打结缝线锚定技术修复，第2组（“无结组”）的膝关节采用无结缝线锚定技术修复。对修复强度进行生物力学测试。
结果
进行了循环加载测试。在0 - 20 N单周期测试中，打结锚定组的等效刚度平均值为5.28 N/mm，无结锚定组的等效刚度平均值为5.48 N/mm。5 - 20 N双周期测试结果为，打结组为8.29 N/mm，无结组为8.66 N/mm。在5 - 20 N 100周期测试中，打结组的等效刚度平均值为8.59 N/mm，无结组为10.18 N/mm。打结组的伸长量为5.83 mm，无结组为4.86 mm。进行破坏载荷测试后，记录到打结组的破坏力为237.83 N，无结组为204.90 N。破坏测试伸长值，打结组为26.83 mm，无结组为18.70 mm。破坏能量，打结组为3.87 J，无结组为1.83 J。除了直至破坏的伸长量（p = 0.009）外，两组测试之间无显著差异（p>0.05）。第2组的平均伸长量显著更小，表明无结锚定具有优势，与缝合锚定相比，半月板偏移更小。
结论
在防止半月板偏移方面，无结锚定比打结锚定具有机械优势。与关节镜手术中的技术简单性相结合考虑，无结锚定可安全用于半月板根部韧带的固定。
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