Apostolakos John M, Garcia Alexander R, Buchalter Wyatt H, Hollenbeck Justin F M, Hackett Thomas R, Viola Randall W
Steadman Philippon Research Institute, Vail, CO, USA.
The Steadman Clinic, Vail, CO, USA.
JSES Rev Rep Tech. 2024 Jun 3;4(3):424-430. doi: 10.1016/j.xrrt.2024.05.006. eCollection 2024 Aug.
Previous studies of the cortical suspensory button (CSB) implant have analyzed fixation strength as a function of suture type and surgical technique, but knot configuration remains an area of interest. This study investigates 4-strand knot configurations in CSB suspensory fixation, specifically comparing the use of 2 separate knots with a single knot. We hypothesize that using 2 knots on the distal side of the CSB with #2 suture will yield the strongest and stiffest suspensory fixation.
Two types of knot configurations were compared: a single knot with all 4 suture strands versus 2 independent knots with 2 suture strands each (1 knot from inner strands and 1 knot from outer strands). They were tested using #2 or 2-0 suture, and at distal (on top of the button) or proximal (underneath the button) knot positions. Mechanical testing on the Instron measured ultimate failure load, elongation at failure, and stiffness. Statistical analyses (Shapiro-Wilk, unpaired Student's -tests, and Chi-square tests) assessed differences in strength, stiffness, elongation, and failure mode between knot configurations within each CSB construct combination.
With #2 suture, 2 knots across the CSB resulted in higher load to failure compared to 1 knot in both proximal (467.00 N vs. 554.66 N, = .026) and distal (395.18 N vs. 526.51 N, < .001) locations. Furthermore, 2 knots provided higher stiffness than 1 knot in both proximal (53.24 N/mm vs. 67.89 N/mm, < .001) and distal (47.08 N/mm vs. 56.73 N/mm, = .041) knot locations. However, using 2-0 suture showed no significant differences in failure load and stiffness regardless of knot location.
Using #2 suture and tying 2 independent knots across the CSB increased load to failure and stiffness compared to using only 1 knot regardless of knot position. Thus, if using #2 suture, it is recommended to tie 2 knots to enhance construct strength. However, with 2-0 suture, the number of knots did not impact construct strength. Therefore, if using 2-0 suture, 1 knot can be used to save time. Knot position did not significantly affect the strength or stiffness of the CSB construct, emphasizing the importance of considering knot prominence and surgical approach for determining knot location.
先前关于皮质悬吊纽扣（CSB）植入物的研究分析了固定强度与缝线类型和手术技术的关系，但结的构型仍是一个受关注的领域。本研究调查了CSB悬吊固定中4股线结的构型，特别比较了使用2个单独的结与1个结的情况。我们假设在CSB远端使用2个#2缝线的结将产生最强和最硬的悬吊固定。
比较了两种结的构型：一种是4股缝线的单个结，另一种是2个独立的结，每个结由2股缝线组成（1个结由内线组成，1个结由外线组成）。使用#2或2-0缝线，并在远端（纽扣上方）或近端（纽扣下方）结位置进行测试。在英斯特朗材料试验机上进行力学测试，测量极限破坏载荷、破坏时的伸长率和刚度。统计分析（夏皮罗-威尔克检验、非配对学生t检验和卡方检验）评估了每种CSB结构组合内结构型之间在强度、刚度、伸长率和破坏模式方面的差异。
使用#2缝线时，在近端（467.00 N对554.66 N，P = 0.026）和远端（395.18 N对526.51 N，P < 0.001）位置，CSB上的2个结导致的破坏载荷均高于1个结。此外，在近端（53.24 N/mm对67.89 N/mm，P < 0.001）和远端（47.08 N/mm对56.73 N/mm，P = 0.041）结位置，2个结的刚度均高于1个结。然而，使用2-0缝线时，无论结的位置如何，破坏载荷和刚度均无显著差异。
与仅使用1个结相比，使用#2缝线并在CSB上系2个独立的结可增加破坏载荷和刚度，且与结的位置无关。因此，如果使用#2缝线，建议系2个结以增强结构强度。然而，对于2-0缝线，结的数量不影响结构强度。因此，如果使用2-0缝线，可使用1个结以节省时间。结的位置对CSB结构的强度或刚度没有显著影响，强调了在确定结的位置时考虑结的突出程度和手术入路的重要性。
