Department of Orthopaedics, University of Colorado School of Medicine, Aurora, Colorado, U.S.A.
Department of Orthopaedics, University of Colorado School of Medicine, Aurora, Colorado, U.S.A..
Arthroscopy. 2022 Mar;38(3):1019-1027. doi: 10.1016/j.arthro.2021.09.017. Epub 2021 Oct 2.
To compare the biomechanical properties of the knotted versus knotless transosseous-equivalent (TOE) techniques for rotator cuff repair (RCR).
A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines using PubMed, Embase, and the Cochrane Library to identify studies that compared the biomechanical properties of knotted and knotless TOE RCR techniques. The search phrase used was as follows: (Double Row) AND (rotator cuff) AND (repair) AND (biomechanical). Evaluated properties included ultimate load to failure, cyclic displacement, stiffness, footprint characteristics, and failure mode.
Eight studies met the inclusion criteria, including a total of 67 specimens in each group. Of 6 studies reporting on ultimate load to failure, 4 found tendons repaired with the knotted TOE technique to experience significantly higher ultimate load to failure compared with knotless TOE repairs (knotted range, 323.5-549.0 N; knotless range, 166.0-416.8 N; P < .05). Of 6 studies reporting on failure stiffness, 2 found knotted TOE repairs to have significantly higher failure stiffness compared with knotless TOE repairs (knotted range, 30.0-241.8 N/mm; knotless range, 28.0-182.5 N/mm; P < .05), whereas 1 study found significantly higher failure stiffness in knotless TOE repairs compared with knotted TOE repairs (P = .039). Cyclic gap formation favored the knotted TOE group in 2 of 3 studies (knotted range, 0.6-5.2 mm; knotless range, 0.4-9.1 mm; P < .05). The most common mode of failure in both groups was suture tendon tear.
On the basis of the included cadaveric studies, rotator cuff tendons repaired via the knotted TOE technique display superior time-zero biomechanical properties, including greater ultimate load to failure, compared with rotator cuffs repaired via the knotless TOE technique. Suture tearing through the tendon remains a common failure method for both techniques.
The results of this systematic review provide helpful insight into the biomechanical differences between 2 popular techniques for RCR. Although these results should be carefully considered by surgeons who are using either of these techniques in the operating room, they should not be mistaken for direct clinical applicability because cadaveric studies may not directly correlate to clinical outcomes.
比较带线锚钉与无结线锚钉经骨隧道技术修复肩袖撕裂的生物力学特性。
根据 PRISMA 指南，系统检索 PubMed、Embase 和 Cochrane 图书馆，以“（双排）和（肩袖）和（修复）和（生物力学）”为检索词，收集比较带线锚钉与无结线锚钉经骨隧道技术修复肩袖撕裂的生物力学特性的研究。评估的性能包括最终失效负载、循环位移、刚度、足印特征和失效模式。
纳入 8 项研究，共纳入 67 个标本。在 6 项报告最终失效负载的研究中，4 项研究发现带线锚钉修复的肩袖撕裂的最终失效负载显著高于无结线锚钉修复（带线锚钉组范围为 323.5-549.0 N；无结线锚钉组范围为 166.0-416.8 N；P<.05）。在 6 项报告失效刚度的研究中，2 项研究发现带线锚钉修复的肩袖撕裂的失效刚度显著高于无结线锚钉修复（带线锚钉组范围为 30.0-241.8 N/mm；无结线锚钉组范围为 28.0-182.5 N/mm；P<.05），而 1 项研究发现无结线锚钉修复的失效刚度显著高于带线锚钉修复（P=0.039）。在 3 项研究中，有 2 项研究发现带线锚钉组的循环间隙形成优于无结线锚钉组（带线锚钉组范围为 0.6-5.2 mm；无结线锚钉组范围为 0.4-9.1 mm；P<.05）。两组最常见的失效方式均为缝线肌腱撕裂。
根据纳入的尸体研究，与无结线锚钉修复相比，带线锚钉修复的肩袖撕裂在初始即刻的生物力学性能更优，包括更大的最终失效负载。缝线肌腱撕裂仍然是两种技术共同的失效方式。
本系统评价的结果为两种常用的肩袖撕裂修复技术的生物力学差异提供了有益的见解。尽管这些结果应该引起手术室中使用这两种技术的外科医生的注意，但由于尸体研究可能与临床结果并不直接相关，因此不应将这些结果误认为是直接的临床适用性。
