Background:The essential component of managing femoroacetabular impingement involves restoration of the original labral function. Circumferential labral reconstruction (CLR) has shown positive results. However, biomechanical studies of CLR are limited and have not established the efficacy of the modern knotless all-suture anchor (ASA) pull-through technique.Hypotheses:(1) CLR with knotless ASA fixation will restore native labral suction seal biomechanics; (2) tensioning the ASA to a high-tension state will increase the peak distractive force.Study Design:Controlled laboratory study.Methods:Eight fresh-frozen human cadaveric hips were dissected free of all soft tissue except the native labrum and transverse acetabular ligament. On an electromechanical testing system, the hips were compressively loaded to 250 N to initiate a suction seal and distracted at a rate of 10 mm/s until rupture of the suction seal. Hips were tested in 4 states: intact labrum, full labral removal, knotless CLR with moderate anchor tension, and CLR with high anchor tension. Peak distractive force (in newtons) was compared using repeated measures analysis of variance ( P < .05). Acetabular bevel angles (θ) were measured at labral clockface positions outside the transverse acetabular ligament using a 3-dimensional digitizer stylus after rim preparation. Linear regression plots compared θ and peak distractive force in the CLR state.Results:Peak force values were 138.5 ± 13.6 N (mean ± SE) for the intact labrum, 18.4 ± 2.79 N for labral excision, 95.4 ± 23.3 N for moderate-tension CLR, and 126.2 ± 27.3 N for high-tension CLR. Significant differences were observed only when full labral removal was compared with the other conditions: intact ( P < .001), moderate-tension CLR ( P = .016), and high-tension CLR ( P = .002). Steeper acetabular bevel angles (smaller θ) were correlated with greater suction seal restoration ( P < .05).Conclusion:CLR restored distractive stability on average to 82.0% of the intact value after labral deficiency. Retensioning did not significantly increase peak distractive forces.Clinical Relevance:These findings provide biomechanical validation supporting CLR using knotless ASAs in an effort to minimize volumetric bone loss and provide other surgical advantages. The prepared rim's bevel angle may be an important variable to optimize for improved suction seal restoration.

中文翻译：

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使用无结全缝合锚栓进行环形盂唇重建可恢复髋关节牵引稳定性：尸体生物力学分析


背景： 处理股骨髋臼撞击的重要组成部分包括恢复原始盂唇功能。环状盂唇重建 （CLR） 已显示出积极的结果。然而，CLR 的生物力学研究有限，尚未确定现代无结全缝合锚 （ASA） 拉穿技术的疗效。假设：（1） 无结 ASA 固定的 CLR 将恢复天然盂唇吸合生物力学;（2） 将 ASA 张紧到高压状态会增加峰值牵引力。研究设计： 对照实验室研究。方法： 解剖 8 例新鲜冷冻的人尸体髋关节，除天然盂唇和髋臼横韧带外，无其他软组织。在机电测试系统上，髋关节被压缩加载至 250 N 以启动吸力密封，并以 10 mm/s 的速率分散注意力，直到吸力密封破裂。在 4 种状态下测试了髋关节：完整盂唇、完全盂唇切除、锚定张力适中的无结 CLR 和锚定张力高的 CLR。使用重复测量方差分析 （P < .05） 比较峰值牵引力 （以牛顿为单位）。在轮辋准备后，使用 3 维数字化测针在髋臼横韧带外的盂唇钟面位置测量髋臼斜面角度 （θ）。线性回归图比较了 CLR 状态下的 θ 和峰值牵引力。结果： 完整盂唇的峰值力值为 138.5 ± 13.6 N （平均值 ± SE），盂唇切除的峰值为 18.4 ± 2.79 N，中张力 CLR 为 95.4 ± 23.3 N，高压 CLR 为 126.2 ± 27.3 N。只有当将完全盂唇切除与其他情况进行比较时，才观察到显著差异：完整 （ P < .001）、中度张力 CLR （ P = .016） 和高压 CLR （ P = .002） 的 CLR 的 CLR 的 1 个值。较陡的髋臼斜角 （较小的 θ） 与较大的吸合恢复相关 （ P < .05）。结论： CLR 在盂唇缺损后将牵引稳定性平均恢复到完整值的 82.0%。重新张紧并没有显着增加峰值牵引力。临床相关性： 这些发现提供了生物力学验证，支持使用无结 ASA 的 CLR，以尽量减少体积骨丢失并提供其他手术优势。准备好的轮辋的斜角可能是优化以改善吸力密封修复的重要变量。