Gilat Ron, Khan Zeeshan A, Villareal-Espinosa Juan Bernardo, Bi Andrew S, Jawanda Harkirat S, Jackson Garrett R, Gursoy Safa, Mameri Enzo S, Shewman Elizabeth F, Kaplan Daniel J, Gelber Pablo E, Chahla Jorge
Rush University Medical College, Chicago, Illinois, U.S.A.
Rush University Medical College, Chicago, Illinois, U.S.A.; Acibadem University, Istanbul, Turkey.
Arthroscopy. 2025 Jul 1. doi: 10.1016/j.arthro.2025.06.029.
To evaluate the biomechanical properties and failure mechanisms of lateral extra-articular tenodesis (LET) performed using onlay staple, inlay interference screw, and onlay all-suture anchor fixation techniques.
Twenty-four nonmatched pairs of human cadaveric knees were randomized to receive a cortical staple (n = 8), an interference screw (n = 8), or an all-suture anchor (n = 8). A modified Lemaire LET technique was performed for all knees using their respective fixation technique. Biomechanical testing was performed using a tensile-testing apparatus (MTS Systems). All knees were subjected to an axially directed preload cycle and subsequently assessed for cyclic and load-to-failure outcomes. Results were analyzed via analysis of variance, Kruskal-Wallis, and post-hoc Tukey tests.
Three staple-fixated LETs failed during the cyclic loading and were excluded from analysis. Average elongation after cyclic loading was 2.89 mm (staple), 2.06 mm (screw), and 3.51 mm (anchor) (P = .134). Average maximum load to failure was 174.1 N (staple), 250.8 N (screw), and 199.2 N (anchor), with a significant between-group difference on analysis of variance testing (P = .023). Post hoc analysis revealed staple fixation had a significantly lower maximum load than interference screw fixation (P = .026). Displacement at maximum load was significantly higher in the anchor group (22.2 mm) compared to the staple (11.3 mm) (P = .05).
While staple fixation resulted in early failure, both interference screw and anchor fixations are viable options for LET, with suture anchors offering less rigidity under high loads when compared with either fixation strategy. However, no differences were observed in elongation during cyclic loading.
Emerging literature has revealed a 70% tunnel convergence rate when utilizing an interference screw for femoral fixation of a LET. The results of the present time-zero cadaveric study explore the role of surface-based fixation methods, given that it may mitigate convergence risk.
评估使用覆盖钉、嵌入干涉螺钉和覆盖全缝线锚钉固定技术进行外侧关节外肌腱固定术（LET）的生物力学特性和失效机制。
将24对非匹配的人体尸体膝关节随机分组，分别接受皮质钉（n = 8）、干涉螺钉（n = 8）或全缝线锚钉（n = 8）固定。对所有膝关节采用改良的勒迈尔LET技术，并使用各自的固定技术。使用拉伸试验装置（MTS系统）进行生物力学测试。所有膝关节均承受轴向预加载循环，随后评估其循环和失效载荷结果。通过方差分析、克鲁斯卡尔 - 沃利斯检验和事后检验进行结果分析。
3个采用钉固定的LET在循环加载过程中失效，被排除在分析之外。循环加载后的平均伸长量分别为：钉固定2.89 mm、螺钉固定2.06 mm、锚钉固定3.51 mm（P = 0.134）。平均最大失效载荷分别为：钉固定174.1 N、螺钉固定250.8 N、锚钉固定199.2 N，方差分析显示组间存在显著差异（P = 0.023）。事后分析表明，钉固定的最大载荷显著低于干涉螺钉固定（P = 0.026）。与钉固定组（11.3 mm）相比，锚钉组在最大载荷时的位移显著更高（22.2 mm）（P = 0.05）。
虽然钉固定导致早期失效，但干涉螺钉和锚钉固定都是LET的可行选择，与任何一种固定策略相比，缝线锚钉在高载荷下的刚性较小。然而，在循环加载过程中的伸长量未观察到差异。
新出现的文献表明，在使用干涉螺钉进行LET的股骨固定时，隧道汇聚率为70%。鉴于基于表面的固定方法可能降低汇聚风险，本零时尸体研究结果探讨了其作用。
