What is the best fixation method in medial patellofemoral ligament reconstruction? A biomechanical comparison of common methods for femoral graft attachment.
IF 1.8
Q2 ORTHOPEDICS
Léonard Vezole, Stanislas Gunst, Laure-Lise Gras, Jobe Shatrov, Ozgur Mertbakan, Sébastien Lustig, Elvire Servien
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Abstract
Introduction: A variety of techniques have been described for femoral fixation in medial patellofemoral ligament reconstruction (MPFLr). The aim of this study was to compare the biomechanical performance of the most used methods for graft fixation in the femur using human cadaveric tissue. We wondered what is the best fixation method for femoral fixation in MPFL reconstruction?
Hypothesis: A suspensory fixation device provides the best femoral fixation.
Material and method: Twenty cadaveric knees were tested. Four femoral fixation methods were compared (5 knees per group): interference fixation with a Biosure© RG 5 mm and a 7 mm, suture anchor (Healicoil Regenesorb 4.75 mm ©) and suspensory fixation with the Ultrabutton©. The testing was divided in preconditioning, cyclic loading and load to failure. Load to failure, elongation, stiffness and mode of failure were recorded and compared.
Results: The Ultrabutton© had the highest mean ultimate load (427 ± 215 N (p = 0.5)), followed by Healicoil anchor © (308 ± 44 N (p > 0.05)) and the interference screw of 7 mm (255 ± 170 N (p > 0.05)). Mean stiffness was similar in the Ultrabutton© and 4.75 mm. Healicoil anchor © groups (111 ± 21 N/mm and 119 ± 20 N/mm respectively), and lowest in 7 mm Biosure© screw fixation group (90 ± 5 N/mm). The Biosure© 5 mm RG screw presented 100% of premature rupture because of tendon slippage. The Ultrabutton© presented the lowest premature rupture (40%).
Discussion: A suspensory fixation for the femur had the lowest number of graft failures and highest load to failure. This study has implications for surgeons' choice of graft fixation in MPFLr. It is the first study to test the most commonly femoral used fixation methods, allowing direct comparisons between each method.
髌骨内侧韧带重建的最佳固定方法是什么?股骨移植物固定常用方法的生物力学比较。
简介:在髌股内侧韧带重建术(MPFLr)中,有多种股骨固定技术。本研究的目的是利用人体尸体组织,比较最常用的股骨移植物固定方法的生物力学性能。我们想知道什么是 MPFL 重建中股骨固定的最佳固定方法?材料和方法:对 20 个尸体膝关节进行了测试。比较了四种股骨固定方法(每组 5 个膝关节):Biosure© RG 5 毫米和 7 毫米干扰固定、缝合锚(Healicoil Regenesorb 4.75 毫米©)和 Ultrabutton© 悬吊固定。测试分为预处理、循环加载和加载至破坏。结果显示:Ultrabutton© 的破坏荷载、伸长率、硬度和破坏模式都得到了记录和比较:结果:Ultrabutton© 的平均极限荷载最高(427 ± 215 牛顿(p = 0.5)),其次是 Healicoil anchor ©(308 ± 44 牛顿(p > 0.05))和 7 毫米过盈螺钉(255 ± 170 牛顿(p > 0.05))。Ultrabutton© 组和 4.75 mm.Healicoil anchor © 组的平均硬度相似(分别为 111 ± 21 牛顿/毫米和 119 ± 20 牛顿/毫米),而 7 毫米 Biosure© 螺钉固定组的平均硬度最低(90 ± 5 牛顿/毫米)。Biosure© 5 毫米 RG 螺钉 100%因肌腱滑动而过早断裂。Ultrabutton©的过早断裂率最低(40%):讨论:股骨悬吊固定的移植失败次数最少,失败载荷最高。这项研究对外科医生选择 MPFLr 移植固定具有重要意义。这是第一项测试最常用的股骨固定方法的研究,可对每种方法进行直接比较。
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