Cargando…

Anatomic Knot Suture Anchor Versus Knotless Suture Anchor Technique for Anterior Talofibular Ligament Repair: A Biomechanical Comparison

BACKGROUND: To date, there are few biomechanical studies comparing the strength between knot repair and knotless repair procedures for anterior talofibular ligament (ATFL) injury. PURPOSE: To perform a biomechanical comparison of the strength of the arthroscopic ATFL repair technique with knot or kn...

Descripción completa

Detalles Bibliográficos
Autores principales: Li, Hong, Xu, Hanlin, Hua, Yinghui, Chen, Wenbo, Li, Hongyun, Chen, Shiyi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6985968/
https://www.ncbi.nlm.nih.gov/pubmed/32047832
http://dx.doi.org/10.1177/2325967119898125
_version_ 1783491884875776000
author Li, Hong
Xu, Hanlin
Hua, Yinghui
Chen, Wenbo
Li, Hongyun
Chen, Shiyi
author_facet Li, Hong
Xu, Hanlin
Hua, Yinghui
Chen, Wenbo
Li, Hongyun
Chen, Shiyi
author_sort Li, Hong
collection PubMed
description BACKGROUND: To date, there are few biomechanical studies comparing the strength between knot repair and knotless repair procedures for anterior talofibular ligament (ATFL) injury. PURPOSE: To perform a biomechanical comparison of the strength of the arthroscopic ATFL repair technique with knot or knotless suture anchors in a cadaveric model with partial or complete ATFL injuries. STUDY DESIGN: Controlled laboratory study. METHODS: A total of 24 fresh-frozen cadaveric ankles were used. Arthroscopy was used to identify, section, and repair the ATFL on the fibular insertion site. The specimens were then randomly placed into 1 of 4 groups: group A received complete ATFL section and 1–suture anchor repair with knot, group B received complete ATFL section and 1-anchor knotless repair, group C received partial ATFL section and 1–suture anchor repair with knot, and group D received partial ATFL section and 1-anchor knotless repair. After repair, the ATFL tension was measured first with a digitalized tensiometer. Specimens were then mounted on a materials testing system to determine the ultimate load to failure and stiffness. RESULTS: The mean ± SD ligament tension measured during the arthroscopic procedure was 8.6 ± 0.6 N for group A, 9.2 ± 0.5 N for group B, 9.4 ± 1.1 N for group C, and 9.6 ± 0.9 N for group D. No significant difference in tension was detected among groups. In load-to-failure testing, the mean ultimate failure load was 27.9 ± 4.1 N for group A, 26.2 ± 9.3 N for group B, 81.9 ± 26.5 N for group C, and 88.1 ± 41.6 N for group D. The mean ultimate failure loads of the partial repair groups were significantly higher than those of the complete repair groups (C vs A, P = .008; D vs B, P = .002), while there was no significant difference between groups A and B (P > .05) or between groups C and D (P > .05). CONCLUSION: The results of the present study showed that there was no significant difference in biomechanical properties between knot repair and knotless repair techniques. CLINICAL RELEVANCE: Biomechanically, the results showed that knot suture anchor and knotless suture repair provide similar biomechanical strength for ATFL injury. Unfortunately, these methods in the complete ATFL section models provided less than half the strength and stiffness in the partial ATFL section models at time zero after surgery. As a result, 1–suture anchor repair is not suitable for complete ATFL injury regardless of the repair method.
format Online
Article
Text
id pubmed-6985968
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher SAGE Publications
record_format MEDLINE/PubMed
spelling pubmed-69859682020-02-11 Anatomic Knot Suture Anchor Versus Knotless Suture Anchor Technique for Anterior Talofibular Ligament Repair: A Biomechanical Comparison Li, Hong Xu, Hanlin Hua, Yinghui Chen, Wenbo Li, Hongyun Chen, Shiyi Orthop J Sports Med Article BACKGROUND: To date, there are few biomechanical studies comparing the strength between knot repair and knotless repair procedures for anterior talofibular ligament (ATFL) injury. PURPOSE: To perform a biomechanical comparison of the strength of the arthroscopic ATFL repair technique with knot or knotless suture anchors in a cadaveric model with partial or complete ATFL injuries. STUDY DESIGN: Controlled laboratory study. METHODS: A total of 24 fresh-frozen cadaveric ankles were used. Arthroscopy was used to identify, section, and repair the ATFL on the fibular insertion site. The specimens were then randomly placed into 1 of 4 groups: group A received complete ATFL section and 1–suture anchor repair with knot, group B received complete ATFL section and 1-anchor knotless repair, group C received partial ATFL section and 1–suture anchor repair with knot, and group D received partial ATFL section and 1-anchor knotless repair. After repair, the ATFL tension was measured first with a digitalized tensiometer. Specimens were then mounted on a materials testing system to determine the ultimate load to failure and stiffness. RESULTS: The mean ± SD ligament tension measured during the arthroscopic procedure was 8.6 ± 0.6 N for group A, 9.2 ± 0.5 N for group B, 9.4 ± 1.1 N for group C, and 9.6 ± 0.9 N for group D. No significant difference in tension was detected among groups. In load-to-failure testing, the mean ultimate failure load was 27.9 ± 4.1 N for group A, 26.2 ± 9.3 N for group B, 81.9 ± 26.5 N for group C, and 88.1 ± 41.6 N for group D. The mean ultimate failure loads of the partial repair groups were significantly higher than those of the complete repair groups (C vs A, P = .008; D vs B, P = .002), while there was no significant difference between groups A and B (P > .05) or between groups C and D (P > .05). CONCLUSION: The results of the present study showed that there was no significant difference in biomechanical properties between knot repair and knotless repair techniques. CLINICAL RELEVANCE: Biomechanically, the results showed that knot suture anchor and knotless suture repair provide similar biomechanical strength for ATFL injury. Unfortunately, these methods in the complete ATFL section models provided less than half the strength and stiffness in the partial ATFL section models at time zero after surgery. As a result, 1–suture anchor repair is not suitable for complete ATFL injury regardless of the repair method. SAGE Publications 2020-01-27 /pmc/articles/PMC6985968/ /pubmed/32047832 http://dx.doi.org/10.1177/2325967119898125 Text en © The Author(s) 2020 https://creativecommons.org/licenses/by-nc-nd/4.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License (https://creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Article
Li, Hong
Xu, Hanlin
Hua, Yinghui
Chen, Wenbo
Li, Hongyun
Chen, Shiyi
Anatomic Knot Suture Anchor Versus Knotless Suture Anchor Technique for Anterior Talofibular Ligament Repair: A Biomechanical Comparison
title Anatomic Knot Suture Anchor Versus Knotless Suture Anchor Technique for Anterior Talofibular Ligament Repair: A Biomechanical Comparison
title_full Anatomic Knot Suture Anchor Versus Knotless Suture Anchor Technique for Anterior Talofibular Ligament Repair: A Biomechanical Comparison
title_fullStr Anatomic Knot Suture Anchor Versus Knotless Suture Anchor Technique for Anterior Talofibular Ligament Repair: A Biomechanical Comparison
title_full_unstemmed Anatomic Knot Suture Anchor Versus Knotless Suture Anchor Technique for Anterior Talofibular Ligament Repair: A Biomechanical Comparison
title_short Anatomic Knot Suture Anchor Versus Knotless Suture Anchor Technique for Anterior Talofibular Ligament Repair: A Biomechanical Comparison
title_sort anatomic knot suture anchor versus knotless suture anchor technique for anterior talofibular ligament repair: a biomechanical comparison
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6985968/
https://www.ncbi.nlm.nih.gov/pubmed/32047832
http://dx.doi.org/10.1177/2325967119898125
work_keys_str_mv AT lihong anatomicknotsutureanchorversusknotlesssutureanchortechniqueforanteriortalofibularligamentrepairabiomechanicalcomparison
AT xuhanlin anatomicknotsutureanchorversusknotlesssutureanchortechniqueforanteriortalofibularligamentrepairabiomechanicalcomparison
AT huayinghui anatomicknotsutureanchorversusknotlesssutureanchortechniqueforanteriortalofibularligamentrepairabiomechanicalcomparison
AT chenwenbo anatomicknotsutureanchorversusknotlesssutureanchortechniqueforanteriortalofibularligamentrepairabiomechanicalcomparison
AT lihongyun anatomicknotsutureanchorversusknotlesssutureanchortechniqueforanteriortalofibularligamentrepairabiomechanicalcomparison
AT chenshiyi anatomicknotsutureanchorversusknotlesssutureanchortechniqueforanteriortalofibularligamentrepairabiomechanicalcomparison