Placement of sutures for inside-out meniscal repair: both sutures through meniscal tissue reduces displacement on cyclical loading

Satoshi Yamakawa,Shoji Konda,Tatsuo Mae,Ken Nakata,Takehito Hirose,Issei Ogasawara

doi:10.1186/s40634-021-00417-z

Satoshi Yamakawa, Shoji Konda + Show 4 more

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https://doi.org/10.1186/s40634-021-00417-z

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Abstract

PurposeThe inside-out meniscal repair is widely performed to preserve the function of meniscus. In this technique, the outer suture is passed through the capsule as well as the outer meniscus, while the inner suture is inserted into the meniscus. The aim of this study was to biomechanically compare the suture stability between meniscus-meniscus and meniscus-capsule suture methods for the longitudinal meniscal tear with inside-out technique.MethodsTwenty-seven porcine knees were dissected to maintain the femur-medial capsule/meniscus-tibia complex, and the inner meniscus was cut off along the meniscus circumferential fiber with 3 mm width of the peripheral meniscus preserved. After one needle with a 2-0 polyester suture was inserted into the inner portion of the meniscus, the other needle was inserted through 1) the peripheral meniscus (Group A), 2) capsule just above the meniscus (Group B), and 3) capsule at 10 mm apart from the meniscus-capsule junction (Group C) in the inside-out manner. Then, the suture was manually tied on the capsule. The suture gap at the repair site during 300 times of cyclic loading and the ultimate failure load in the load-to-failure test were measured. The statistical significance of the data between two groups in each combination was considered by Bonferroni correction, following a one-way analysis of variance.ResultsIn the cyclic loading test, the suture gap was 0.68 ± 0.26 mm in Group A, 1.08 ± 0.36 mm in Group B, and 1.94 ± 0.57 mm in Group C with a significant difference. In the load-to-failure test, the ultimate failure load was 59.1 ± 13.6 N in Group A, 60.0 ± 7.9 N in Group B, and 57.4 ± 4.7 N in Group C, and there was no significant difference.ConclusionThe stitching region in the inside-out technique for longitudinal meniscal tear affected the stability of the tear site, and stitching the mid-substance region of the meniscus provides good stability in response to cyclic tensile loading. In addition, the stitching region did not affect the ultimate failure load.Clinical relevanceIn the inside-out meniscal repair, the outer suture should be inserted into the remaining peripheral meniscus or the capsule near the meniscus.

Highlights

The meniscus plays important roles such as shock absorption, joint stabilization, load transmission, and lubrication in the knee joint [2, 13, 19, 21, 26]
In case of meniscal repair including capsule, as the strength of the meniscus is quite different from the strength of capsule, the capsule can be damaged by suture material compared to the meniscus
Aık et al compared the suture strength using bovine knees in meniscal repair among 5 suture techniques; horizontal mattress, vertical mattress, knot-end, vertical, and vertical loop, and described that the largest ultimate failure load occurred in the vertical mattress suture technique

Summary

Introduction

The meniscus plays important roles such as shock absorption, joint stabilization, load transmission, and lubrication in the knee joint [2, 13, 19, 21, 26]. Longitudinal meniscal tear in the red zone (blood supplied zone) is the best for meniscal repair, while the inside-out technique is commonly applied to meniscus repair [9]. The effect of the difference between stitching regions (meniscus-meniscus vs meniscus-capsule) on post-surgical stability is unclear, though the secure and strong suture method in meniscal repair is required to achieve satisfactory outcomes. As this report applied the tensile test to the meniscus without synovial capsule, ligaments and bones [1], the condition was different from the physiological state. Iuchi et al firstly clarified the suture strength in meniscal repair for the physiological meniscus attached to the synovial capsules and bones [15]. The aim of the present study was to biomechanically compare the suture stability between meniscus-meniscus and meniscus-capsule suture techniques for the longitudinal meniscal tear in the physiological condition. Our hypotheses were 1) the gap of suture site in the meniscus-capsular suture technique was larger than that in the meniscus-meniscus technique during the cyclic loading test and 2) the failure load did not differ between those techniques

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