Increased Construct Stiffness With Meniscal Repair Sutures and Devices Increases the Risk of Cheese-Wiring During Biomechanical Load-to-Failure Testing.
Increased Construct Stiffness With Meniscal Repair Sutures and Devices Increases the Risk of Cheese-Wiring During Biomechanical Load-to-Failure Testing.
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半月板修复缝合和装置增加的结构刚度增加了在生物力学载荷-失败测试期间干酪接线的风险。
DOI：
10.1177/23259671211015674
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发表时间：
2021-06
影响因子：
2.6
通讯作者：
Rosso C
中科院分区：
文献类型：
--
作者：
Müller S;Schwenk T;de Wild M;Dimitriou D;Rosso C
半月板缝合是半月板修复中的一个众所周知的问题。到目前为止，对影响因素的认识还不够充分，研究也不够充分。目的：研究修复缝合线和器械的结构刚度是否与载荷-失效测试中的缝合穿透(筒状接线)相关。对照实验室研究。在131只猪半月板上，采用自内向外缝合(0号Ultrabraid，2-0 Orthocord，2-0 FiberWire，2-0 Ethiond)或全内固定装置(65例，FastFix360，Omnispanand半月板)修复纵向半月板桶柄撕裂。循环加载后，进行加载失效试验。记录失效模式和结构刚度。通过对受试者工作特性曲线的分析，确定了预测半月板修复失败的最佳刚度阈值。采用双尾t检验和方差分析进行显著性检验。在所有标本中，缝线固定丢失是最常见的失败模式(58%)，除了Omnispan板，最常见的失败是由于锚定拉开。OMNISPAN最高(30.8±3.5N/mm)，半月板(18.0±8.8N/mm)和Ethiond(19.4±7.8N/mm)最低。OMNISPAN的硬度明显高于半月板半月板(P<；.001)和Ethiond(P=.02)，而半月板半月板的硬度显著低于FiberWire(P=.01)、Ultrabraid(P=.04)和FastFix360(P=.03)。结构刚度高的半月板修复失败更多的是使用奶酪钢丝，而刚性较低的半月板修复失败的原因是失去缝线固定、打结滑脱或锚定拉开。半月板修复的硬度为26.5N/mm的半月板修复，在负载到失败测试期间，由于奶酪状接线而失败的风险是后者的3.6倍(95%CI，1.4-8.2；P<；0.0001)。采用内向外缝合和全内置器的半月板修复，结构刚度较高(>；26.5N/mm)，通过缝合切开(筒状钢丝)修复半月板比使用较低硬度(≤26.5N/mm)的半月板更容易失败。这是首次研究结构刚度对半月板缝合穿透修复失败的影响。
Cheese-wiring, the suture that cuts through the meniscus, is a well-known issue in meniscal repair. So far, contributing factors are neither fully understood nor sufficiently studied. To investigate whether the construct stiffness of repair sutures and devices correlates with suture cut-through (cheese-wiring) during load-to-failure testing. Controlled laboratory study. In 131 porcine menisci, longitudinal bucket-handle tears were repaired using either inside-out sutures (n = 66; No. 0 Ultrabraid, 2-0 Orthocord, 2-0 FiberWire, and 2-0 Ethibond) or all-inside devices (n = 65; FastFix360, Omnispan, and Meniscal Cinch). After cyclic loading, load-to-failure testing was performed. The mode of failure and construct stiffness were recorded. A receiver operating characteristic curve analysis was performed to define the optimal stiffness threshold for predicting meniscal repair failure by cheese-wiring. The 2-tailed t test and analysis of variance were used to test significance. Loss of suture fixation was the most common mode of failure in all specimens (58%), except for the Omnispan, which failed most commonly because of anchor pull-through. The Omnispan demonstrated the highest construct stiffness (30.8 ± 3.5 N/mm), whereas the Meniscal Cinch (18.0 ± 8.8 N/mm) and Ethibond (19.4 ± 7.8 N/mm) demonstrated the lowest construct stiffness. The Omnispan showed significantly higher stiffness compared with the Meniscal Cinch (P < .001) and Ethibond (P = .02), whereas the stiffness of the Meniscal Cinch was significantly lower compared with that of the FiberWire (P = .01), Ultrabraid (P = .04), and FastFix360 (P = .03). While meniscal repair with a high construct stiffness more often failed by cheese-wiring, meniscal repair with a lower stiffness failed by loss of suture fixation, knot slippage, or anchor pull-through. Meniscal repair with a stiffness >26.5 N/mm had a 3.6 times higher risk of failure due to cheese-wiring during load-to-failure testing (95% CI, 1.4-8.2; P < .0001). Meniscal repair using inside-out sutures and all-inside devices with a higher construct stiffness (>26.5 N/mm) was more likely to fail through suture cut-through (cheese-wiring) than that with a lower stiffness (≤26.5 N/mm). This is the first study investigating the impact of construct stiffness on meniscal repair failure by suture cut-through (cheese-wiring).
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