Chuang Hao-Chun, Yen Joe-Zhi, Hong Chih-Kai, Hsu Kai-Lan, Kuan Fa-Chuan, Chen Yueh, Chang Hao-Ming, Su Wei-Ren
Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Skeleton Materials and Bio-compatibility Core Laboratory, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Orthop J Sports Med. 2022 Mar 24;10(3):23259671211072523. doi: 10.1177/23259671211072523. eCollection 2022 Mar.
Despite the increasing prevalence of tape-type sutures, whether internal knotless anchors can consistently affix tape-type sutures has not been thoroughly investigated.
To evaluate whether substituting tape-type sutures for conventional sutures influences the suture-holding strength of internal knotless anchors.
Controlled laboratory study. Level of evidence, 5.
A total of 3 internal knotless anchors were tested: a spiral core clamping anchor (Footprint Ultra PK), a winged clamping anchor (PopLok), and a spooling anchor (ReelX STT). Four constructs were compared for each type of anchor, with the anchor double or quadruple loaded with tape-type sutures or conventional sutures. The testing protocol comprised preloading suture tension to 10 N; cyclic loading, in which tension increased in increments of 10 N from 10 to 90 N; and a load-to-failure stage set at a speed of 0.5 mm/s. The clinical failure load (CFL) was defined as suture slippage of ≥3 mm. Also, 1-way analysis of variance and power analysis were used to compare the CFLs of the constructs.
For the quadruple-loaded spiral core clamping anchors, a significant reduction in CFLs was seen with conventional sutures over tape-type sutures (138.10 ± 4.73 vs 80.00 ± 12.25 N, respectively; < .001). This reduction was not observed under the double-loaded condition (conventional vs tape type: 76.00 ± 5.48 vs 80.00 ± 10.00 N, respectively). Substitution of the suture materials did not significantly reduce the CFLs for the winged clamping anchors (conventional vs tape type: 40.00 ± 10.00 vs 30.00 ± 7.07 N for double loaded, respectively, and 64.00 ± 13.41 vs 50.00 ± 10.00 N for quadruple loaded, respectively) or the spooling anchors (conventional vs tape type: 62.00 ± 19.23 vs 56.32 ± 20.20N for double loaded, respectively, and 72.00 ± 21.68 vs 84.00 ± 13.42 N for quadruple loaded, respectively).
Substituting tape-type sutures for conventional sutures increased the CFLs of some internal knotless anchors. With specific suture-anchor combinations, quadruple-loaded conventional suture anchors had CFLs higher than those of double-loaded conventional suture anchors.
When multiple tape-type sutures are used in conjunction with a clamping anchor, clinicians should note a possible reduction in CFLs and resultant early suture slippage.
尽管带型缝线的使用日益普遍，但无结内固定锚钉能否始终如一地固定带型缝线尚未得到充分研究。
评估用带型缝线替代传统缝线是否会影响无结内固定锚钉的缝线固定强度。
对照实验室研究。证据等级，5级。
共测试了3种无结内固定锚钉：螺旋芯夹锚（Footprint Ultra PK）、翼形夹锚（PopLok）和卷轴锚（ReelX STT）。每种类型的锚钉比较4种构建方式，锚钉分别双重或四重加载带型缝线或传统缝线。测试方案包括将缝线预加载张力至10 N；循环加载，张力从10 N以10 N的增量增加至90 N；以及以0.5 mm/s的速度设置失效载荷阶段。临床失效载荷（CFL）定义为缝线滑移≥3 mm。此外，使用单因素方差分析和功效分析来比较各构建方式的CFL。
对于四重加载的螺旋芯夹锚，传统缝线的CFL显著低于带型缝线（分别为138.10±4.73 N和80.00±12.25 N；P<0.001）。在双重加载条件下未观察到这种降低（传统缝线与带型缝线：分别为76.00±5.48 N和80.00±10.00 N）。缝线材料的替代并未显著降低翼形夹锚（双重加载时传统缝线与带型缝线分别为40.00±10.00 N和30.00±7.07 N，四重加载时分别为64.00±13.41 N和50.00±10.00 N）或卷轴锚（双重加载时传统缝线与带型缝线分别为62.00±19.23 N和56.32±20.20 N，四重加载时分别为72.00±21.68 N和84.00±13.42 N）的CFL。
用带型缝线替代传统缝线可提高某些无结内固定锚钉的CFL。对于特定的缝线-锚钉组合，四重加载的传统缝线锚钉的CFL高于双重加载的传统缝线锚钉。
当多种带型缝线与夹锚联合使用时，临床医生应注意CFL可能降低以及由此导致的早期缝线滑移。
