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外文期刊>Orthopaedic Journal of Sports Medicine
>Interference Screw Versus Suture Anchors for Femoral Fixation in Medial Patellofemoral Ligament Reconstruction: A Biomechanical Study
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Interference Screw Versus Suture Anchors for Femoral Fixation in Medial Patellofemoral Ligament Reconstruction: A Biomechanical Study
Background: Femoral-sided graft fixation in medial patellofemoral ligament (MPFL) reconstruction is commonly performed using an interference screw (IS). However, the IS method is associated with several clinical disadvantages that may be ameliorated by the use of suture anchors (SAs) for femoral fixation. Purpose: To compare the load to failure and stiffness of SAs versus an IS for the femoral fixation of a semitendinosus autograft in MPFL reconstruction. Study Design: Controlled laboratory study. Methods: Based on a priori power analysis, a total of 6 matched pairs of cadaveric knees were included. Specimens in each pair were randomly assigned to receive either SA or IS fixation. After an appropriate reconstruction procedure, the looped end of the MPFL graft was pulled laterally at a rate of 6 mm/s until construct failure. The best-fit slope of the load-displacement curve was then used to calculate the stiffness (N/mm) in a post hoc fashion. A paired t test was used to compare the mean load to failure and the mean stiffness between groups. Results: No significant difference in load to failure was observed between the IS and the SA fixation groups (294.0 ± 61.1 vs 250.0 ± 55.9; P = .352), although the mean stiffness was significantly higher in IS specimens (34.5 ± 9.6 vs 14.7 ± 1.2; P = .004). All IS reconstructions failed by graft pullout from the femoral tunnel, whereas 5 of the 6 SA reconstructions failed by anchor pullout. Conclusion: In this biomechanical study using a cadaveric model of MPFL reconstruction, SA femoral fixation was not significantly different from IS fixation in terms of load to failure. The mean load-to-failure values for both reconstruction techniques were greater than the literature-reported values for the native MPFL. Clinical Relevance: These results suggest that SAs are a biomechanically viable alternative for femoral-sided graft fixation in MPFL reconstruction.
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机译：背景：股骨双面移植物固定在内侧髌韧带通常使用干涉螺钉（IS）中进行（MPFL）重建。然而，IS方法与若干临床缺点可以通过使用缝合锚钉（SAS）对股骨固定来改善相关联。目的：比较负载故障和SA的刚度相对于一个在MPFL重建一个半腱移植的股骨固定IS。研究设计：受控实验室研究。方法：基于先验功率分析，总共6个配对尸体膝盖都包括在内。在每对样本被随机分配接受SA或IS固定。适当的重建程序后，将MPFL接枝的环形端在6mm的速率横向拉动/秒，直到构建体故障。然后将负载 - 位移曲线的最佳拟合斜率，使用了事后方式来计算刚度（N /毫米）。配对t检验用于比较平均负载故障和组之间的平均刚度。结果：之间的IS和SA固定组（294.0±61.1 250.0 VS 55.9±; P = 0.352）观察到的在负载故障无显著差异，尽管平均刚度为显著高于IS试样（34.5±9.6 VS 14.7 ±1.2; P = 0.004）。所有从股骨隧道通过接枝拉出失败重建，而6个SA重建的5未能通过锚拉出。结论：在使用MPFL重建的尸体模型这个生物力学研究，SA股骨内固定并没有从IS内固定失效负载方面显著不同。两种重建技术的平均负载到故障值比对天然MPFL文献报告的值越大。临床相关性：这些结果表明，SA是用于MPFL重建股骨双面移植物固定生物力学可行的替代方案。
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