Nacov Julia A, Kammerlohr Sandra, Staat Manfred, Buess Eduard, Leschinger Tim, Wegmann Kilian, Müller Lars P, Hackl Michael
Faculty of Medicine, University of Cologne, Cologne, Germany.
Department of Orthopaedics and Trauma Surgery, University Hospital Cologne, Cologne, Germany.
Orthop J Sports Med. 2025 Apr 14;13(4):23259671241302069. doi: 10.1177/23259671241302069. eCollection 2025 Apr.
Numerous single- and double-row repair techniques with simple and modified stitches have been described for subscapularis tendon tears.
PURPOSE/HYPOTHESIS: This study aimed to uniformly evaluate the influence of 4 different repair techniques on the biomechanical performance of fixation for full-thickness subscapularis tendon tears. It was hypothesized that (1) the 2 modified single-row repair techniques would require more cycles to result in 3- and 5-mm gap formation and have a higher load to failure after cyclic loading than the simple single-row repair technique and (2) the double-row repair technique would also require more cycles to result in 3- and 5-mm gap formation and have a significantly higher load to failure after cyclic loading compared to the simple single-row repair technique.
Controlled laboratory study.
Full-thickness subscapularis tendon tears were created in 32 fresh-frozen cadaveric shoulders, and the tears were treated in 1 of 4 ways: (1) single-row repair with the mattress stitch, (2) single-row repair with the modified lasso-loop stitch, (3) single-row repair with the modified Mason-Allen stitch, or (4) double-row repair. After repair, specimens were progressively cyclically loaded to 200 N, and the number of cycles to obtain a 3- and 5-mm gap was recorded. After cyclic loading, the specimens were loaded to failure at 500 mm/min, and ultimate failure loads were measured.
There were no significant differences between either of the modified single-row repair techniques and the simple single-row repair technique. Double-row repair withstood significantly more cycles until 3-mm ( < .001) and 5-mm ( = .004) gap formation and had a higher ultimate failure load ( = .015) compared to the simple single-row repair technique, and double-row repair withstood more cycles until 3-mm gap formation ( = .003) compared with single-row repair with the modified lasso-loop stitch. No significant differences were found between double-row repair and single-row repair with the modified Mason-Allen stitch.
Findings indicated that (1) there was no significant biomechanical advantage of the modified single-row repair techniques over the simple single-row repair technique and (2) while the double-row repair technique was biomechanically superior to the simple single-row repair technique, there was no significant difference between single-row repair with the modified Mason-Allen stitch and double-row repair.
Considering that double-row repair might not be useful in some tears because of the risk of overtensioning, modified single-row repair techniques appear to be an adequate refixation alternative.
对于肩胛下肌腱撕裂，已经描述了许多采用简单和改良缝线的单排和双排修复技术。
目的/假设：本研究旨在统一评估4种不同修复技术对全层肩胛下肌腱撕裂固定生物力学性能的影响。假设如下：（1）与简单单排修复技术相比，两种改良单排修复技术在形成3毫米和5毫米间隙时需要更多的循环次数，并且在循环加载后具有更高的破坏载荷；（2）与简单单排修复技术相比，双排修复技术在形成3毫米和5毫米间隙时也需要更多的循环次数，并且在循环加载后具有显著更高的破坏载荷。
对照实验室研究。
在32个新鲜冷冻尸体肩部制造全层肩胛下肌腱撕裂，并采用以下4种方法之一进行治疗：（1）褥式缝线单排修复；（2）改良套索环缝线单排修复；（3）改良梅森-艾伦缝线单排修复；或（4）双排修复。修复后，将标本逐渐循环加载至200 N，并记录形成3毫米和5毫米间隙所需的循环次数。循环加载后，以500毫米/分钟的速度将标本加载至破坏，并测量极限破坏载荷。
改良单排修复技术中的任何一种与简单单排修复技术之间均无显著差异。与简单单排修复技术相比，双排修复在形成3毫米（P<0.001）和5毫米（P = 0.004）间隙之前能够承受更多的循环次数，并且具有更高的极限破坏载荷（P = 0.015），与改良套索环缝线单排修复相比，双排修复在形成3毫米间隙之前能够承受更多的循环次数（P = 0.003）。双排修复与改良梅森-艾伦缝线单排修复之间未发现显著差异。
研究结果表明：（1）改良单排修复技术相对于简单单排修复技术没有显著的生物力学优势；（2）虽然双排修复技术在生物力学上优于简单单排修复技术，但改良梅森-艾伦缝线单排修复与双排修复之间没有显著差异。
考虑到由于过度张紧的风险，双排修复在某些撕裂中可能无用，改良单排修复技术似乎是一种合适的重新固定选择。
