Biomechanical Properties of Meniscal Repair Using a Suture Loop, All-Inside Suture Anchor-Based, and Inside-Out Vertical Mattress Suture: A Porcine Study

Abstract

Background: Repairing the meniscus can be challenging in certain situations, such as when tears occur in the posterolateral corner of the knee or when there is insufficient tissue in the medial or lateral meniscus for traditional vertical mattress or commercially available suture anchorbased techniques. The all-inside suture loop technique could address these challenges; however, its biomechanical properties have not yet been compared to the standard techniques. Objective: To compare the biomechanical properties of the meniscal repair techniques. Materials and Methods: The present study was a controlled laboratory study (in-vitro). Thirty porcine menisci from 15 mature, fresh-frozen porcine knee joints without signs of degeneration were utilized. A vertical tear, parallel to the peripheral rim of the meniscus was created. Biomechanical properties were tested and compared among all-inside suture loop, all-inside vertical mattress using a suture anchor-based repair device, and the standard inside-out vertical mattress technique. A one-way ANOVA was used to assess differences among groups. Post-hoc Tukey’s honest significance test was conducted for multiple comparisons. Results: Load-to-failure was similar among the three groups for the three techniques, the suture loop 83.7±25.2 N versus anchor-based 92.7±41.8 N versus vertical mattress 66.8±17.1 N, (p=0.162). The suture loop and vertical mattress meniscal repair techniques exhibited greater stiffness than anchor-based technique (p=0.014 and 0.001, respectively). Additionally, the suture loop and vertical mattress techniques demonstrated less displacement than the anchor-based techniques (p<0.001 for both). Conclusion: The all-inside suture loop technique demonstrated a comparable load-to-failure when compared to the standard vertical mattress and suture anchor-based technique. It also exhibited greater stiffness than the suture anchor-based technique. Considering the biomechanical properties, as well as the advantages of accommodating even small amounts of meniscal tissue remaining for repair with other techniques, avoiding injury to the popliteus tendon, and preventing knee joint stiffness, the suture loop technique could be a viable option for meniscal repair. Keywords: Meniscus repair; All-inside suture loop; Biomechanical property