The Johns Hopkins University, Baltimore, Maryland, USA.
Am J Sports Med. 2021 Sep;49(11):3125-3131. doi: 10.1177/0363546520986999. Epub 2021 Feb 17.
Various surgical techniques can be used to repair acute distal biceps tendon (DBT) tears; however, it is unknown which type of repair or implant has the greatest biomechanical strength and presents the lowest risk of type 2 failure.
To identify associations between the type of implant or construct used and the biomechanical performance of DBT repairs in a review of human cadaveric studies.
Systematic review and meta-regression.
We systematically searched the EMBASE and Medline (PubMed) databases for biomechanical studies that evaluated DBT repair performance in cadaveric specimens. Two independent reviewers extracted data from 14 studies that met our inclusion criteria. The pooled data set was subjected to meta-regression with adjusted failure load (AFL) as the primary outcome variable. Procedural parameters, such as number of sutures, cortices, locking stitches, and whipstitches, served as covariates. Adjusted analysis was performed to determine the differences among implant types. The alpha level was set at .05.
When using no implant (bone tunnels) as the referent, no fixation type or procedural parameter was significantly better at predicting AFL. Cortical button fixation had the highest AFL (370 N; 95% CI, -2 to 221). In an implant-to-implant comparison, suture anchor alone was significantly weaker than cortical button (154 N; 95% CI, 30 to 279). Constructs using a cortical button and interference screw were not stronger (as measured by AFL) than those using a cortical button alone. The presence of a locking stitch added 113 N (95% CI, 29 to 196) to the AFL. The use of cortical button instead of interference screws or bone tunnels was associated with lower odds of type 2 failure. Avoiding locking stitches and using more sutures in the construct were also associated with lower odds of type 2 failure.
Cortical button fixation is associated with greater construct strength than is suture anchor repair and a lower risk of type 2 failure compared with interference screw fixation or fixation without implants. The addition of an interference screw to cortical button fixation was not associated with increased strength. The presence of a locking stitch added 113 N to the failure load but also increased the odds of type 2 failure.
各种外科技术可用于修复急性远端二头肌肌腱（DBT）撕裂；然而，尚不清楚哪种类型的修复或植入物具有最大的生物力学强度，并且发生 2 型失败的风险最低。
在对人体尸体研究的综述中，确定使用的植入物或结构类型与 DBT 修复的生物力学性能之间的关联。
系统评价和荟萃回归。
我们系统地检索了 EMBASE 和 Medline（PubMed）数据库，以评估尸体标本中二头肌修复性能的生物力学研究。两名独立的评审员从符合纳入标准的 14 项研究中提取数据。将汇总数据集进行荟萃回归分析，以调整后的失效负荷（AFL）作为主要结局变量。手术参数，如缝线数量、皮质骨、锁定缝线和鞭缝线，作为协变量。进行调整分析以确定不同植入物类型之间的差异。α 水平设定为 0.05。
当以无植入物（骨隧道）作为参照时，没有任何固定类型或手术参数在预测 AFL 方面明显更好。皮质纽扣固定的 AFL 最高（370N；95%CI，-2 至 221）。在植入物与植入物的比较中，单独使用缝线锚定明显弱于皮质纽扣（154N；95%CI，30 至 279）。使用皮质纽扣和干涉螺钉的结构并不比单独使用皮质纽扣的结构更强（以 AFL 衡量）。锁定缝线的存在使 AFL 增加了 113N（95%CI，29 至 196）。使用皮质纽扣代替干涉螺钉或无植入物与较低的 2 型失败风险相关。避免锁定缝线并在结构中使用更多缝线也与较低的 2 型失败风险相关。
皮质纽扣固定与缝线锚定修复相比，具有更大的结构强度，与干扰螺钉固定或无植入物固定相比，2 型失败的风险较低。向皮质纽扣固定中添加干涉螺钉与增加强度无关。锁定缝线的存在使失效负荷增加了 113N，但也增加了 2 型失败的几率。
