Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, New York, USA.
Am J Sports Med. 2021 Mar;49(3):773-779. doi: 10.1177/0363546520985184. Epub 2021 Feb 5.
Previous studies comparing stability between single- and double-row arthroscopic bony Bankart repair techniques focused only on the measurements of tensile forces on the bony fragment without re-creating a more physiologic testing environment.
To compare dynamic stability and displacement between single- and double-row arthroscopic repair techniques for acute bony Bankart lesions in a concavity-compression cadaveric model simulating physiologic conditions.
Controlled laboratory study.
Testing was performed on 13 matched pairs of cadaveric glenoids with simulated bony Bankart fractures with a defect width of 25% of the inferior glenoid diameter. Half of the fractures were repaired with a double-row technique, and the contralateral glenoids were repaired with a single-row technique. To determine dynamic biomechanical stability and ultimate step-off of the repairs, a 150-N load and 2000 cycles of internal-external rotation at 1 Hz were applied to specimens to simulate early rehabilitation. Toggle was quantified throughout cycling with a coordinate measuring machine. Three-dimensional spatial measurements were calculated. After cyclic loading, the fracture displacement was measured.
The bony Bankart fragment-glenoid initial step-off was found to be significantly greater ( < .001) for the single-row technique (mean, 896 µm; SD, 282 µm) compared with the double-row technique (mean, 436 µm; SD, 313 µm). The motion toggle was found to be significantly greater ( = .017) for the single-row technique (mean, 994 µm; SD, 711 µm) compared with the double-row technique (mean, 408 µm; SD, 384 µm). The ultimate interface displacement was found to be significantly greater ( = .029) for the single-row technique (mean, 1265 µm; SD, 606 µm) compared with the double-row technique (mean, 795 µm; SD, 398 µm).
Using a concavity-compression glenohumeral cadaveric model, we found that the double-row arthroscopic fixation technique for bony Bankart repair resulted in superior stability and decreased displacement during simulated rehabilitation when compared with the single-row repair technique.
The findings from this study may help guide surgical decision-making by demonstrating superior biomechanical properties (improved initial step-off, motion toggle, and interface displacement) of the double-row bony Bankart repair technique when compared with single-row fixation. The double-row repair construct demonstrated increased stability of the bony Bankart fragment, which may improve bony Bankart healing.
之前比较单排和双排关节镜下骨 Bankart 修复技术稳定性的研究仅关注于骨碎片的拉伸力测量，而没有重建更符合生理的测试环境。
在模拟生理条件的凹陷压缩尸体模型中，比较急性骨 Bankart 损伤中单排和双排关节镜修复技术的动态稳定性和位移。
对照实验室研究。
对 13 对模拟有骨 Bankart 骨折的尸体肩盂进行测试，骨折缺陷宽度为下盂直径的 25%。一半的骨折采用双排技术修复，对侧肩盂采用单排技术修复。为了确定修复的动态生物力学稳定性和最终台阶位移，施加 150-N 的负荷和 1 Hz 内-外旋转 2000 次循环，以模拟早期康复。使用坐标测量机在整个循环过程中量化枢轴。计算三维空间测量值。循环加载后，测量骨折位移。
发现单排技术（平均 896 µm；SD，282 µm）的骨 Bankart 骨片-盂初始台阶位移明显大于（<.001）双排技术（平均 436 µm；SD，313 µm）。发现单排技术（平均 994 µm；SD，711 µm）的运动枢轴明显大于（=.017）双排技术（平均 408 µm；SD，384 µm）。发现单排技术（平均 1265 µm；SD，606 µm）的最终界面位移明显大于（=.029）双排技术（平均 795 µm；SD，398 µm）。
使用凹陷压缩肱骨头尸体模型，我们发现与单排修复技术相比，双排关节镜下骨 Bankart 修复技术在模拟康复过程中具有更好的稳定性和更小的位移。
本研究结果可能有助于通过比较双排骨 Bankart 修复技术的生物力学性能（改善初始台阶、运动枢轴和界面位移）来指导手术决策。双排修复结构显示出骨 Bankart 碎片的稳定性增加，这可能改善骨 Bankart 愈合。
