Derksen Alexander, Balli Zarife, Windhagen Henning, Nebel Dennis, Reifenrath Janin
Department of Orthopaedic Surgery, Hannover Medical School, DIAKOVERE Annastift, Anna-Von-Borries-Str. 1-7, 30625, Hannover, Germany.
Laboratory for Biomechanics and Biomaterials, Department of Orthopaedic Surgery, Hannover Medical School, DIAKOVERE Annastift, Anna-Von-Borries-Str. 1-7, 30625, Hannover, Germany.
J Orthop Traumatol. 2025 May 24;26(1):33. doi: 10.1186/s10195-025-00850-1.
Gluteus medius tendon tears lead to considerable functional limitations and a high level of suffering in affected patients. In cases where the symptoms are severe, surgical intervention is indicated. A range of techniques are used to repair the tendon, with the primary aim being to achieve the highest possible primary stability in order to minimise the risk of re-rupture. This biomechanical study compares two different refixation techniques in terms of their stability in an ovine model.
The gluteal tendons of sheep hips (n = 17) were meticulously prepared and detached from the femoral insertion. To reattach these tendons at their original anatomical footprint, either the sole double-row transosseous-equivalent technique (DR) or the DR supplemented by a proximal suture insertion (augmentation) of the tendon (DR +) was used. Pull-out tests were performed until failure using a uniaxial material testing machine, with a tensile force applied along the physiological tensile direction of the hip abductors. The data obtained (force at failure, linear stiffness) were compared between the groups using the Mann-Whitney U test.
The augmentation of the proximal tendon portion resulted in a substantial increase in force at failure, exceeding 450% (698 ± 80.3 N DR + compared with 155.9 ± 53.9 N DR technique). In addition, augmented tendons exhibited a notable enhancement in stiffness, with an average increase of 31.3 ± 15 N/mm in DR + compared with 12.4 ± 4.8 N/mm in DR. Furthermore, the DR + method resulted in a substantial reduction in the incidence of slippage of the tendon fibres out of the sutures and tendon bundles when compared with the DR suture.
The clinical problem of suture knots becoming loose within the tendon stump, leading to the failure of the tendon sutures, could be mitigated by additional augmentation, resulting in a substantial increase in ultimate load at failure. The benefits of the double-row transosseous-equivalent technique, which facilitates the pressing of the tendon stump against the footprint, are maintained. Level of Evidence Level of Evidence 5.
臀中肌腱撕裂会给受影响患者带来相当大的功能限制和极大痛苦。在症状严重的情况下，需进行手术干预。一系列技术用于修复肌腱，主要目的是实现尽可能高的初始稳定性，以降低再次断裂的风险。本生物力学研究在羊模型中比较了两种不同的重新固定技术的稳定性。
精心准备17只羊髋部的臀肌腱并从股骨附着处分离。为将这些肌腱重新附着于其原始解剖足迹，采用了单纯的双排骨隧道等效技术（DR）或通过在肌腱近端缝合插入（增强）来补充的DR技术（DR +）。使用单轴材料试验机进行拔出试验直至失效，沿髋外展肌的生理拉伸方向施加拉力。使用曼-惠特尼U检验比较两组获得的数据（失效时的力、线性刚度）。
肌腱近端部分的增强导致失效时的力大幅增加，超过450%（DR +组为698±80.3 N，而DR技术组为155.9±53.9 N）。此外，增强后的肌腱刚度显著提高，DR +组平均增加31.3±15 N/mm，而DR组为12.4±4.8 N/mm。此外，与DR缝合相比，DR +方法使肌腱纤维从缝线和肌腱束中滑脱的发生率大幅降低。
通过额外增强可缓解肌腱残端内缝合结松动导致肌腱缝合失败这一临床问题，从而使失效时的极限载荷大幅增加。双排骨隧道等效技术便于将肌腱残端压靠在足迹上的优点得以保留。证据水平 证据水平5。
