Acosta Jonathan, Rinaldi John M, Guth J Jared, Akhavan Sam
Department of Orthopaedic Surgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA.
Orthop J Sports Med. 2020 Sep 23;8(9):2325967120952315. doi: 10.1177/2325967120952315. eCollection 2020 Sep.
Secure tendon grasping is critical to the success of any tenodesis procedure. Several techniques currently used for tendon grasping can result in longitudinal splitting of the tendon, causing construct failure and failure of the tenodesis.
To compare the Loop 'n' Tack knot as a tendon-grasping technique with other common suture techniques. We investigated the biomechanical strength and mode of failure.
Controlled laboratory study.
Eleven matched pairs of proximal biceps were harvested from fresh-frozen cadaveric shoulders. One tendon from each pair was stitched using 1 of 4 different techniques. The suture techniques evaluated included the Loop 'n' Tack with 2 different types of high-strength nonabsorbable suture, a double half-racking stitch, and a Krakow stitch. Samples were cyclically loaded between 5 and 20 N for 100 cycles, followed by a pull to failure at 33 mm/s.
The Loop 'n' Tack techniques were equivalent to the double half-racking and Krakow techniques for load to ultimate failure ( = .817 and = .984, respectively). The double half-racking technique was the stiffest construct, which was significantly greater than the second-stiffest group, the Loop 'n' Tack method with both FiberLink suture ( = .012) and SutureTape ( = .002), which had greater stiffness than the Krakow group ( < .001). The most common failure mode for the Loop 'n' Tack stitch was suture breakage compared with the Krakow and double half-racking methods, where the most common mode of failure was suture pullout from the tendon ( < .001).
Biomechanical testing found that the Loop 'n' Tack techniques had similar ultimate load to failure values when compared with the double half-racking and Krakow methods. Mode-of-failure analysis showed that the Loop 'n' Tack construct typically failed by suture breakage, whereas the other techniques failed by suture pullout.
The Loop 'n' Tack technique allows for secure grasping of tissue without the need for externalization of the tendon. This technique may be beneficial in compromised or poor-quality tissue without reducing overall pullout strength when compared with a standard half-racking or Krakow stitch.
牢固地抓取肌腱对于任何肌腱固定术的成功都至关重要。目前用于抓取肌腱的几种技术可能会导致肌腱纵向裂开，从而导致结构失效和肌腱固定术失败。
将“环扣”结作为一种肌腱抓取技术与其他常见缝合技术进行比较。我们研究了其生物力学强度和失效模式。
对照实验室研究。
从新鲜冷冻的尸体肩部获取11对匹配的肱二头肌近端。每对中的一条肌腱使用4种不同技术中的1种进行缝合。评估的缝合技术包括使用2种不同类型高强度不可吸收缝线的“环扣”结、双半绞锁缝合法和克氏缝合法。样本在5至20 N之间循环加载100次，然后以33 mm/s的速度拉伸至破坏。
“环扣”结技术在极限破坏载荷方面与双半绞锁缝合法和克氏缝合法相当（分别为 = 0.817和 = 0.984）。双半绞锁缝合法构建的结构最僵硬，显著大于第二僵硬的组，即使用FiberLink缝线（ = 0.012）和缝合带（ = 0.002）的“环扣”结方法，其刚度大于克氏缝合法组（ < 0.001）。与克氏缝合法和双半绞锁缝合法相比，“环扣”结缝合最常见的失效模式是缝线断裂，克氏缝合法和双半绞锁缝合法最常见的失效模式是缝线从肌腱中拔出（ < 0.001）。
生物力学测试发现，与双半绞锁缝合法和克氏缝合法相比，“环扣”结技术的极限破坏载荷值相似。失效模式分析表明，“环扣”结构建的结构通常因缝线断裂而失效，而其他技术因缝线拔出而失效。
“环扣”结技术无需将肌腱引出体外即可牢固抓取组织。与标准半绞锁缝合法或克氏缝合法相比，该技术在组织受损或质量较差的情况下可能有益，且不会降低整体拔出强度。
