Department of Orthopedic Surgery, Henry Ford Health, Detroit, Michigan, U.S.A..
Department of Orthopedic Surgery, Henry Ford Health, Detroit, Michigan, U.S.A.
Arthroscopy. 2024 Jan;40(1):149-161. doi: 10.1016/j.arthro.2023.05.016. Epub 2023 May 23.
To evaluate the literature on suture anchor (SA) usage for patellar tendon repair, summarize the overall biomechanical and clinical outcomes, and assess whether the cumulative research supports the adoption of this technique compared with transosseous (TO) repair.
A systematic literature review using the Preferred Reporting Items for Systematic and Meta-Analyses guidelines was performed. Multiple electronic databases were searched to identify studies focusing on surgical outcomes of patellar tendon repair with suture anchor usage. Cadaver and animal biomechanical studies, technical studies, and clinical studies were included.
A total of 29 studies met the inclusion criteria: 6 cadaver, 3 animal, 9 technical, and 11 clinical reports. Four of the 6 cadaver studies and 1 of the 2 animal studies found significantly less gap formation from SA than from TO repair. Average gap formation in human studies ranged from 0.9 to 4.1 mm in the SA group compared with 2.9 to 10.3 mm in TO groups. Load to failure was significantly stronger in 1 of 5 cadaver studies and 2 of 3 animal studies, with human studies SA load to failure ranging from 258 to 868 N and TO load to failure ranging from 287 to 763 N. There were 11 clinical studies that included 133 knees repaired using SA. Nine studies showed no difference between complication rate or risk for reoperation, where one study reported a significantly lower re-rupture rate after SA repair compared with TO repair.
SA repair is a viable option for patellar tendon repair and could have several advantages over TO repair. Multiple studies indicate that SA repair has less gap formation during biomechanical testing compared with TO repair in human cadaver and animal models. No differences in complications or revisions were found in the majority of clinical studies.
Both animal and human models suggest SA fixation has potential biomechanical benefits when compared with TO tunnels for patellar tendon repair, whereas clinical studies show no difference in complications and revisions postoperatively.
评估关于缝线锚（SA）用于髌腱修复的文献，总结总体生物力学和临床结果，并评估该技术是否比经骨（TO）修复更具优势。
使用系统评价和荟萃分析首选报告项目指南进行系统文献回顾。检索多个电子数据库，以确定使用缝线锚进行髌腱修复的手术结果的研究。纳入尸体和动物生物力学研究、技术研究和临床研究。
共有 29 项研究符合纳入标准：6 项尸体研究、3 项动物研究、9 项技术研究和 11 项临床报告。6 项尸体研究中的 4 项和 2 项动物研究中的 1 项发现，SA 的间隙形成明显少于 TO 修复。人类研究中平均间隙形成范围在 SA 组为 0.9 至 4.1mm，TO 组为 2.9 至 10.3mm。5 项尸体研究中的 1 项和 3 项动物研究中的 2 项发现，失效负荷明显更强，人类研究中 SA 的失效负荷范围为 258 至 868N，TO 的失效负荷范围为 287 至 763N。有 11 项临床研究包括使用 SA 修复的 133 个膝关节。9 项研究显示并发症发生率或再次手术风险无差异，其中 1 项研究报告 SA 修复后的再断裂率明显低于 TO 修复。
SA 修复是髌腱修复的一种可行选择，与 TO 修复相比，可能具有多项优势。多项研究表明，在人体尸体和动物模型中，SA 修复的生物力学测试中，间隙形成明显少于 TO 修复。大多数临床研究未发现并发症或翻修方面的差异。
动物和人体模型均表明，与 TO 隧道相比，SA 固定在髌腱修复方面具有潜在的生物力学优势，而临床研究显示术后并发症和翻修无差异。
