Abstract
PurposeMeniscal surgery is one of the most common orthopaedic surgical interventions. Total meniscus replacements have been proposed as a solution for patients with irreparable meniscal injuries. Reliable fixation is crucial for the success and functionality of such implants. The aim of this study was to characterise an interference screw fixation system developed for a novel fibre-matrix-reinforced synthetic total meniscus replacement in an ovine cadaveric model.MethodsTextile straps were tested in tension to failure (n = 15) and in cyclic tension (70–220 N) for 1000 cycles (n = 5). The textile strap-interference screw fixation system was tested in 4.5 mm-diameter single anterior and double posterior tunnels in North of England Mule ovine tibias aged > 2 years using titanium alloy (Ti6Al4Va) and polyether-ether-ketone (PEEK) screws (n ≥ 5). Straps were preconditioned, dynamically loaded for 1000 cycles in tension (70–220 N), the fixation slippage under cyclic loading was measured, and then pulled to failure.ResultsStrap stiffness was at least 12 times that recorded for human meniscal roots. Strap creep strain at the maximum load (220 N) was 0.005 following 1000 cycles. For all tunnels, pull-out failure resulted from textile strap slippage or bone fracture rather than strap rupture, which demonstrated that the textile strap was comparatively stronger than the interference screw fixation system. Pull-out load (anterior 544 ± 119 N; posterior 889 ± 157 N) was comparable to human meniscal root strength. Fixation slippage was within the acceptable range for anterior cruciate ligament graft reconstruction (anterior 1.9 ± 0.7 mm; posterior 1.9 ± 0.5 mm).ConclusionThese findings show that the textile attachment-interference screw fixation system provides reliable fixation for a novel ovine meniscus implant, supporting progression to in vivo testing. This research provides a baseline for future development of novel human meniscus replacements, in relation to attachment design and fixation methods. The data suggest that surgical techniques familiar from ligament reconstruction may be used for the fixation of clinical meniscal prostheses.
Highlights
At the first 70–220 N load cycle, the tensile strain of the textile straps at 220 N was 0.016 ± 0.003; this increased to 0.021 ± 0.004 after 1000 cycles (Fig. 2)
No slippage of the textile straps was detected at the clamp jaws during testing
The most important findings of this study were that the fixation strength of the novel total meniscus replacement interference screw fixation system was similar to that of human meniscal root attachments, and that the resistance to slipping under cyclic loads was similar to that of well-established
Summary
Meniscal injury significantly affects quality of life [32], and meniscal surgery is one of the most common orthopaedic surgical interventions worldwide [1, 7, 18, 32], with 1 million meniscal surgeries occurring annually in the United States alone [21]. Approximately 15–35% of meniscus tears are repairable [8, 33]. When meniscus repair is not possible, the current standard of care is meniscectomy for symptomatic tears having failed non-surgical treatment. Other treatment options, including meniscal allograft transplants [22, 35] and partial replacement scaffolds [21, 23, 30, 34, 42], have limited success in long-term function and survivorship [14, 15, 41]. Novel total meniscus replacement devices have been proposed to fill this treatment gap [19, 26, 37]
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