Biomechanical Comparison of 3 Syndesmosis Repair Techniques With Suture Button Implants.

Autor:	Parker AS; American Sports Medicine Institute, Birmingham, Alabama, USA., Beason DP; American Sports Medicine Institute, Birmingham, Alabama, USA., Slowik JS; American Sports Medicine Institute, Birmingham, Alabama, USA., Sabatini JB; University of Alabama at Birmingham, Birmingham, Alabama, USA., Waldrop NE 3rd; Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama, USA.
Jazyk:	angličtina
Zdroj:	Orthopaedic journal of sports medicine [Orthop J Sports Med] 2018 Oct 24; Vol. 6 (10), pp. 2325967118804204. Date of Electronic Publication: 2018 Oct 24 (Print Publication: 2018).
DOI:	10.1177/2325967118804204
Abstrakt:	Background: Suture button fixation of syndesmotic injury is growing in popularity, as it has been shown to provide adequate stability in a more cost-effective manner than screw fixation while allowing more physiologic distal tibiofibular joint motion. However, the optimal repair technique and implant orientation have yet to be determined. Purpose/hypothesis: The purpose of this study was to biomechanically compare 3 suture button construct configurations/orientations for syndesmosis fixation: single, parallel, and divergent. The authors hypothesized that all 3 methods would provide adequate stabilization but that the divergent technique would be the most stable. Study Design: Controlled laboratory study. Methods: The fixation strengths of 3 stabilization techniques with suture button devices were compared with 10 cadaveric legs each (N = 30). Ankle motion under cyclic loading was measured in multiple planes: first in the intact state, then following simulated syndesmosis injury, and then following fixation with 1 of 3 randomly assigned constructs-1 suture button, 2 suture buttons in parallel, and 2 divergent suture buttons. Finally, axial loading with external rotation was applied to failure. Results: All syndesmotic fixation methods provided stability to the torn state. There was no statistically significant difference among the 3 fixation techniques in biomechanical stability. Failure most commonly occurred through fibular fracture at supraphysiologic loads. Conclusion: Suture button implant fixation for syndesmotic injury appears to provide stability to the torn syndesmosis, and the configuration of the fixation does not appear to affect the strength or security of the stabilization. Clinical Relevance: This study provides further insight into the biomechanics and optimal configuration of suture button fixation of the torn syndesmosis. Based on these results, the addition of a second suture button may not significantly contribute to immediate postoperative stability. Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: This study was supported by Arthrex, which provided direct funding as well as in-kind donations of surgical implants. A.S.P. has received educational support from Stryker, Zimmer/Biomet, and Smith & Nephew. J.B.S. has received hospitality payments from Wright Medical Group. N.E.W. is a consultant for Arthrex, is a paid speaker/presenter for Arthrex and Procedural Orthopedics, has received educational support from Arthrex, has received research support from RTI Surgical, has received royalties from CrossRoads Extremity Systems, and has taught courses for CrossRoads Extremity Systems and Wright Medical. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.
Databáze:	MEDLINE
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