Evaluación biomecánica de reparación de roturas del tendón patelar: ¿Es mejor doble Bunnell paralelo o perpendicular?

Resumen

Introducción En tendón patelar, se ha probado que agregar un segundo punto Bunnell dispuesto perpendicular al punto clásico, es más resistente, sin embargo, esa técnica dispuesta paralelamente no ha sido evaluada.

Propósito Comparar la resistencia entre la técnica doble Bunnell dispuesta en perpendicular y en paralela.

Método 28 muestras frescas de tendones patelares porcinos, asignadas aleatoriamente a 2 grupos. Grupo 1: 14 muestras reparadas con doble Bunnell perpendicular. Grupo 2: 14 muestras reparadas con doble Bunnell paralelo. Todas realizadas con la misma sutura ultrarresistente. Con una máquina computarizada de tracción, se aplicó tracción axial continua hasta el fallo. Se registró el punto máximo de fallo (PMF) y el modelo de falla mecánica. Análisis estadístico con t-student (p < 0,05).

Resultados Grupo 1: PMF = 342 ± 50,7 Newton. Todas las muestras sufrieron avulsión central, preservando fibras perimetrales. Grupo 2: PMF = 358 ± 34,1 Newton. Todas las muestras sufrieron un split longitudinal del tendón. Sin diferencia significativa entre los grupos (p = 0,340).

Conclusión Este estudio no demostró diferencias significativas en la resistencia de una técnica de doble Bunnell paralelo versus perpendicular, aplicada en un modelo experimental de tendón patelar.

Relevancia Clínica Ambas técnicas tienen propiedades biomecánicas similares y dejan un remanente de tejido tendinoso luego del fallo que permitiría una segunda reparación directa, potencialmente sin necesidad de requerir el uso de injertos.

Nivel de Evidencia Estudio de Laboratorio Controlado - Nivel IV.

Abstract

Introduction In the patellar tendon, a second Bunnell stitch arranged perpendicular to the classic configuration has increased the resistance of the repair, however, the effect of a double parallel technique has not been evaluated.

Purpose To compare the resistance between a patellar tendon repair with Double Bunnell technique arranged in parallel or perpendicular.

Method 28 fresh porcine patellar tendon samples were randomly assigned to 2 groups. Group 1: 14 samples repaired with a perpendicular Double Bunnell technique. Group 2: 14 samples repaired with a parallel Double Bunnell technique. All performed with the same ultraresistant suture. The samples were fixed to a computerized traction machine, applying continuous axial traction, until failure. The ultimate failure point (UFP) and the mechanical failure model were recorded. Statistical analysis included student́s t-test (p < 0.05).

Results Group 1: UFP = 342 ± 50.7 Newton. All samples suffered a central avulsion, preserving the perimetral tendon fibers. Group 2: UFP = 358 ± 34.1 Newton. All samples suffered a longitudinal split of the tendon. No significant difference was found among groups (p = 0.340).

Conclusion This biomechanical study showed no significant differences in the strength of a tendon repair using a parallel versus a perpendicular double Bunnell technique.

Clinical Relevance Both techniques have similar biomechanical properties and leave a remnant of tendon tissue after the failure that would allow a second direct repair, potentially without requiring the use of grafts.

Level of Evidence Laboratory Controlled Study - Level IV.

Palabras Clave

reparación tendínea - bunnell - resistencia biomecánica

Keywords

tendon repair - bunnell - biomechanical strength

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