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The Journal of Bone and Joint Surgery, Vol 77, Issue 12 1858-1866, Copyright © 1995 by Journal of Bone and Joint Surgery, Inc
Tendon-healing to cortical bone compared with healing to a cancellous trough. A biomechanical and histological evaluation in goats
P St Pierre, EJ Olson, JJ Elliott, KC O'Hair, LA McKinney and J Ryan
Walter Reed Army Institute of Research, Washington, D.C., USA.
This study was performed to test the hypothesis that attaching a tendon to
a trough in cancellous bone results in tendon-healing that is
biomechanically superior to that after direct fixation of a tendon to
cortical bone. Twenty adult female goats were treated with a bilateral
tenotomy of the infraspinatus tendon with subsequent reattachment of the
tendon. In shoulders randomized to the cancellous-fixation group, a
cancellous bed was prepared with a motorized burr and a template measuring
twenty by five by five millimeters. The repair in the shoulders randomized
to the cortical-fixation group was performed in the same manner, except
that the tendon was attached to cortical bone. Three outcome measures were
assessed, six and twelve weeks after the repair, with the Student paired t
test and analysis of variance: load to failure, energy to failure, and
stiffness. The types of repair were not significantly different with regard
to any of the three outcomes. When the six and twelve-week data were
combined, an average difference in load to failure of 3.9 per cent in favor
of cancellous repair was observed but it was not significant (p = 0.78).
The associated 95 per cent confidence interval for the difference ranged
from 10.5 per cent in favor of cortical repair to 18.3 per cent in favor of
cancellous repair. Histological analysis at six and twelve weeks revealed
progressive maturation and reorganization of the bone-tendon interface with
re-establishment of collagen-fiber continuity between the tendon and bone.
This process was indistinguishable between the cortical and cancellous
specimens. This study demonstrated no significant benefit from the creation
of a trough to expose the tendon to cancellous bone. In this model, at both
six and twelve weeks, the tendon-to-bone healing process of the two groups
appeared similar and the biomechanical properties were approximately equal.
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