Transosealna fiksacija tetive infraspinatusa ovce jednim redom sidara Transosseous fixation of the infraspinatus tendon in a sheep with suture anchor technique

摘要

Rotator cuff tears, and especially supraspinatus tendon ruptures, are quite frequent in patients from their 40 years of age. Rotator cuff is an essential anatomic structure which enables dynamic stabilization of the capitellum. Abolition of rotatory cuff’s function leads to deprivation of the whole arm function. udSurgical reconstruction of damaged cuff with secure and solid fixation is to be performed. That will allow fast mobilization of the arm thus letting patient to recover fast with the minimal risk of rerupture. To achieve this it is necessary to use surgical technique of fixation which provides the largest possible contact of the reconstructed tendon on its’ natural contact spot with the bone. This way the optimal healing process is enabled. udGolden standard of surgical treatment of the rotator cuff rupture is transosseous technique. This technique provides best contact of the reconstructed tendon with its attachment point on greater tuberosity. udFor our study, we chose sheep shoulders, as out of all quadrupeds sheep’s infraspinatus tendon resembles people’s supraspinatus tendon by its position and size to the utmost.udThe study’s goal was to objectify value of the transosseous technique for infraspinatus tendon reconstruction in sheep with usage of single row of anchors. The study was conducted on sixteen female sheep at the age of 3 to 5. By random choice sheep were divided into two groups. In group G1 transosseous method with single row of anchors was used, and in group G2 infraspinatus tendon was sutured with two rows of anchors. Opposite shoulder of each sheep was not treated and those shoulders are regarded as control group GK.udResults show that arthroscopic transosseous technique with single row of anchors after the healing gives greater footprint (293,22 mm2) than arthroscopic method with two row of anchors (145,34 mm2) and even than the natural footprint (170,13 mm2).udMechanical tests results after the healing process show that transosseous method with single row of anchors (G1=301,67 N) provide much greater tearing strength than the method with two rows of anchors (G2=245,96 N). However due to a little number of monitored specimen, difference between two groups was not statistically significant (p=0,477).udAnalysis of graphs and values of elongation at break of separate tendons after mechanical tests of the solidity of reconstruction shows that “suture-tendon-bone” structure in a two-row of anchors method possesses characteristics of brittle materials (distance 11.84 mm) as opposed to transosseous method with single row of anchors (distance 16.82 mm) which structure exhibits properties of elastic materials. Due to its reflexive deformability characteristics, these materials can bear greater tensional force with no irreversible tendon damages.udTearing strength values for both reconstruction techniques (G1 and G2) are approximately only half of tearing strength value in control group (GK=569,00 N).udBased on the results of the study we can conclude that by using transosseous method with single row of anchors and 30% less of materials (anchors and suture material) greater footprint and tearing strength might be achieved in comparison to the technique with two rows of anchors. Consequently, arthroscopic transosseous method with single row of anchors can be recommended for routine clinical usage.