Abstract
The importance of meniscal root integrity to preserve contact load distribution and stability at the knee joint is recognised. Transosseous suture technique is commonly used to repair meniscal root tears. However, clinical results are not completely satisfactory. Specifically, concern exists about the development of substantial displacements at the repaired root. This study aims to assess if the use of a post-insertion tensioning knotless-anchor at the distal exit of the tibial tunnel improves time-zero biomechanical properties of the transtibial repair compared to knotting sutures over a cortical button. Twenty porcine tibia with detached posterior medial meniscal roots were randomized into two groups depending on the method to fix the sutures after root repair: knotless-anchor (KA) or suture-button (SB). Specimens underwent cyclic and load-to-failure testing. Group KA showed significantly smaller residual root displacements after low-level repetitive loads. At the load-to-failure test, Group KA exhibited significantly lower displacements at representative subcritical loads and higher resistance to development of clinically relevant displacements. The authors conclude that use of a knotless suture anchor attached at the distal outlet of the bone tunnel may be an effective solution to reduce root displacements in transtibial meniscal root repairs, a matter reported to alter biomechanics of joint contact.
Highlights
Transosseous repair is the preferred choice for many surgeons, because it is reproducible, facilitates access to the anatomical insertion area and may enhance meniscal healing by allowing marrow content into the articular space
Bone tunnel length resulted similar in both groups with a mean value of 39.53 mm for group suture button (SB) and of 38.80 mm for group knotless anchor (KA), which allowed disregarding the influence of suture length
Root displacements resulted significantly smaller for group KA at minimum and maximum load after 100, 500 and 1000 cycles (Table 1), becoming double for the suture button at both load levels at the end of the test
Summary
Transosseous repair is the preferred choice for many surgeons, because it is reproducible, facilitates access to the anatomical insertion area and may enhance meniscal healing by allowing marrow content into the articular space. A recent work monitored the meniscus-suture interface and found no macroscopic damage at the meniscus-suture boundary up to a load close to ultimate failure[13]. Sutures are frequently fixed by tying them over a cortical button or a post at the distal end of the bone tunnel exit. The purpose of this study was to compare, in an in vitro porcine model, the initial biomechanical properties of transtibial root repairs using two different methods to fix the sutures: knotting them over a suture button (SB) or with a knotless anchor (KA) that allows post-insertion tensioning attached to the anterior tibial cortex. The study hypothesis was that the KA method provides lower displacements and higher resistance than the SB method
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