Abstract
PurposeThe aim of this study was to (1) develop suture techniques in repairing radial meniscal tear; (2) to compare the biomechanical properties of the proposed repair techniques with the conventional double horizontal technique.MethodsThirty-six fresh-frozen porcine medial menisci were randomly assigned into four groups and a complete tear was made at the midline of each meniscus. The menisci were subsequently repaired using four different repair techniques: double vertical (DV), double vertical cross (DVX), hybrid composing one vertical and one horizontal stitch, and conventional double horizontal (DH) suture technique with suturing parallel to the tibia plateau. The conventional double horizontal group was the control. The repaired menisci were subjected to cyclic loading followed by the load to failure testing. Gap formation and strength were measured, stiffness was calculated, and mode of failure was recorded.ResultsGroup differences in gap formation were not statistically significant at 100 cycles (p = .42), 300 cycles (p = .68), and 500 cycles (p = .70). A trend was found toward higher load to failure in DVX (276.8 N, p < .001), DV (241.5 N, p < .001), and Hybrid (237.6 N, p < .001) compared with DH (148.5 N). Stiffness was also higher in DVX (60.7 N/mm, p < .001), DV (55.3 N/mm, p < .01), and Hybrid (52.1 N/mm, p < .01), than DH group (30.5 N/mm). Tissue failure was the only failure mode observed in all specimens.ConclusionOur two proposed vertical suture techniques, as well as the double vertical technique, had superior biomechanical properties than the conventional technique as demonstrated by higher stiffness and higher strength.
Highlights
The knee meniscus plays a key role in joint lubrication, shock absorption, load-bearing and load distribution, it often withstands different forms of forces and is susceptible to injuries [2, 3, 26, 42]
In light of the gap in research evidence and the advancement of medical device used for orthopedic surgery, we proposed two suture techniques for repairing radial meniscal tear: the double vertical cross and the hybrid suture techniques
The objective of this study was to assess the biomechanical properties, including gap formation, strength, and stiffness, of the three vertical two-stitch suture repair techniques compared with the traditional double horizontal suture technique in complete radial tear of the medial menisci
Summary
The knee meniscus plays a key role in joint lubrication, shock absorption, load-bearing and load distribution, it often withstands different forms of forces and is susceptible to injuries [2, 3, 26, 42]. Partial or total meniscectomy – removing the damaged meniscal tissue - was the gold standard to treat meniscal tear [14, 19]. It is widely accepted today that treatment of meniscus tear should preserve the knee meniscal tissue as much as possible [18, 22, 23, 28]. The inside-out/outside-in technique passing horizontal stitches has been commonly used today to treat various types of meniscal tear, it is still inconclusive whether this method is the optimal approach to repair radial meniscal tear [4, 6, 20, 24, 27, 33]. In light of the limitations of the traditional inside-out double horizontal suture used for repairing radial tears [7], novel repair
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