Gould Heath P, Rate William R, Abbasi Pooyan, Mistretta Katherine L, Hammond Jason W
Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, Maryland, USA.
Orthop J Sports Med. 2021 Jan 28;9(1):2325967120974393. doi: 10.1177/2325967120974393. eCollection 2021 Jan.
Adjustable cortical fixation devices have demonstrated utility in orthopaedic applications, such as ankle syndesmosis repair.
To assess the cyclic gap formation of a quadriceps tendon repair technique using an adjustable cortical fixation device compared with repair with knotless suture anchors and suture tape, a modification of conventional suture anchor repair.
Controlled laboratory study.
Eight fresh-frozen matched pairs of cadaveric knees were used. Specimens in each pair were randomized to undergo either modified suture anchor repair (control) or adjustable cortical fixation repair. The control repair was performed as previously described. The experimental repair was performed using 2 No. 2 FiberWire sutures placed into the quadriceps tendon in a running locked Krackow configuration and 2 adjustable loop devices passed through transosseous tunnels. The lagging strands of the devices were tensioned to seat the cortical fixation buttons at the inferior patellar pole and then tied to the free Krackow strands at the superior pole to complete the repair. The mean plastic gap (permanent tendon displacement that did not recover with cyclic extension) and mean maximum gap (peak displacement that occurred with cyclic knee flexion and partially recovered with extension) were evaluated during cyclic loading for 500 cycles of full knee extension to 90° of flexion.
At all testing intervals, the mean plastic gap was significantly smaller for the cortical fixation group versus the suture anchor group ( < .02). Similarly, the mean maximum gap was significantly smaller for the cortical fixation specimens at all testing intervals ( < .01). After cyclic loading, the mean maximum gap was significantly smaller in the cortical fixation group (4.80 ± 1.56 mm) versus the suture anchor group (8.47 ± 1.47 mm; = < .001). The mean plastic gap was also significantly smaller in the cortical fixation versus the suture anchor group (3.25 ± 1.10 mm vs 6.57 ± 1.62 mm, respectively; = < .001).
Quadriceps tendon repair using an adjustable cortical fixation device demonstrated superior biomechanical properties in cyclic displacement testing compared with repair using the suture anchor technique.
These results suggest that an adjustable cortical fixation device is a biomechanically viable alternative for quadriceps tendon repair.
可调节皮质固定装置已在骨科应用中显示出效用，如踝关节联合修复。
评估使用可调节皮质固定装置的股四头肌肌腱修复技术与使用无结缝线锚钉和缝线带（传统缝线锚钉修复的一种改良方法）修复相比的周期性间隙形成情况。
对照实验室研究。
使用八对新鲜冷冻的匹配尸体膝关节标本。每对标本随机分为接受改良缝线锚钉修复（对照组）或可调节皮质固定修复。对照组修复按先前描述进行。实验性修复是将2根2号FiberWire缝线以连续锁定Krackow方式置入股四头肌肌腱，并将2个可调节环装置穿过骨隧道。将装置的滞后股线拉紧，使皮质固定纽扣位于髌骨下极，然后在上极与游离的Krackow股线打结以完成修复。在膝关节从完全伸展到屈曲90°的500次循环加载过程中，评估平均塑性间隙（循环伸展后未恢复的永久性肌腱移位）和平均最大间隙（膝关节循环屈曲时出现的峰值移位，伸展时部分恢复）。
在所有测试间隔，皮质固定组的平均塑性间隙显著小于缝线锚钉组（P <.02）。同样，在所有测试间隔，皮质固定标本的平均最大间隙也显著更小（P <.01）。循环加载后，皮质固定组的平均最大间隙（4.80±1.56mm）显著小于缝线锚钉组（8.47±1.47mm；P =<.001）。皮质固定组的平均塑性间隙也显著小于缝线锚钉组（分别为3.25±1.10mm和6.57±1.62mm；P =<.001）。
与使用缝线锚钉技术修复相比，使用可调节皮质固定装置的股四头肌肌腱修复在循环移位测试中表现出更好的生物力学性能。
这些结果表明，可调节皮质固定装置是股四头肌肌腱修复在生物力学上可行的替代方法。
