Glaeser Brittany M, Bixby Elise C, Hauck Oliver L, Wijdicks Coen A, Riboh Jonathan C
Department of Research, Arthrex, Naples, Florida, USA.
Division of Sports Medicine, Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA.
Orthop J Sports Med. 2025 Aug 7;13(8):23259671251353757. doi: 10.1177/23259671251353757. eCollection 2025 Aug.
The use of adjustable-loop devices (ALDs) has become increasingly common due to the ability to intraoperatively precondition a repair and retension the construct to provide additional stabilization. While ALDs have been supported for anterior cruciate ligament (ACL) repair and reconstruction, a biomechanical rationale for the addition of ALDs for the reduction of tibial eminence avulsion fracture is limited.
To biomechanically compare standard suture fixation to suture fixation with an ALD for the reduction of tibial eminence avulsion fractures.
Controlled laboratory study.
Twenty porcine stifles were dissected of soft tissue, sparing the ACL. Type 3 tibial eminence avulsion fractures were created and reduced with suspensory suture fixation through 1 tunnel using either a standard suture technique (n = 10) or suture fixation with the addition of an ALD (n = 10). Repaired specimens underwent 10 preconditioning cycles to simulate intraoperative knee cycling, manual retensioning (ALD repairs only), cyclic loading between 10 and 50 N, 10 and 100 N, and 10 and 150 N for 100 cycles each, and then pull to failure. Cyclic elongation, cyclic stiffness, and ultimate load outcomes were statistically compared ( < .05).
Total displacement after the cyclic loading protocol showed significantly less total elongation ( < .001) for the ALD group (mean, 0.76 mm; 95% CI, 0.60-0.94 mm) compared with the control group (mean, 5.50 mm; 95% CI, 4.59-6.41 mm). All constructs survived cyclic loading. Significantly higher ultimate loads ( = .023) were achieved by the ALD repairs (mean, 532 N; 95% CI, 461-604 N) compared with the standard repair (mean, 410 N; 95% CI, 327-495 N). There were no statistical differences in cyclic stiffness between repair groups for each load block.
The addition of an ALD to suture fixation for tibial eminence avulsion fractures significantly reduced the total cyclic elongation by 86% and increased the ultimate load by 30% when compared with a standard suture fixation. The results suggest better time-zero biomechanics as compared with standard suture fixation.
Incorporation of ALD fixation into a standard suture repair may help stabilize fragment reduction, minimizing loss of reduction and potentially improving the bone healing response in tibial eminence fracture repair by minimizing micromotion. Future clinical studies are warranted to complement these biomechanical findings.
由于可在术中对修复进行预处理并对构建物进行再张紧以提供额外稳定性，可调环装置（ALD）的使用已变得越来越普遍。虽然ALD已被支持用于前交叉韧带（ACL）修复和重建，但对于添加ALD以减少胫骨髁间隆起撕脱骨折的生物力学原理却很有限。
对标准缝线固定与使用ALD的缝线固定进行生物力学比较，以减少胫骨髁间隆起撕脱骨折。
对照实验室研究。
解剖20个猪膝关节的软组织，保留ACL。制造3型胫骨髁间隆起撕脱骨折，并通过1个隧道使用标准缝线技术（n = 10）或添加ALD的缝线固定（n = 10）进行悬吊缝线固定来复位。修复后的标本进行10个预处理循环以模拟术中膝关节活动，手动再张紧（仅ALD修复），在10至50 N、10至100 N和10至150 N之间进行100个循环的循环加载，然后拉伸至破坏。对循环伸长、循环刚度和极限载荷结果进行统计学比较（P < .05）。
与对照组（平均值为5.50 mm；95%置信区间为4.59 - 6.41 mm）相比，ALD组在循环加载方案后的总位移显示总伸长显著更小（P < .001）（平均值为0.76 mm；95%置信区间为0.60 - 0.94 mm）。所有构建物在循环加载中均存活。与标准修复（平均值为410 N；95%置信区间为327 - 495 N）相比，ALD修复实现了显著更高的极限载荷（P = .023）（平均值为532 N；95%置信区间为461 - 604 N）。各载荷组修复组之间的循环刚度无统计学差异。
与标准缝线固定相比，在胫骨髁间隆起撕脱骨折的缝线固定中添加ALD可使总循环伸长显著减少86%，并使极限载荷增加30%。结果表明与标准缝线固定相比，初始生物力学更好。
将ALD固定纳入标准缝线修复可能有助于稳定骨折块复位，通过最小化微动来减少复位丢失，并可能改善胫骨髁间隆起骨折修复中的骨愈合反应。未来有必要进行临床研究以补充这些生物力学研究结果。
