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Desai SS, Czerwonka N, Farah O, Ruberto RA, Mueller JD, Ferrer X, Chahla J, Trofa DP, Swindell HW. Neither All-Inside, nor Inside-Out, nor Outside-In Repair Demonstrates Superior Biomechanical Properties for Vertical Meniscal Tears: A Systematic Review of Human Cadaveric Studies. Arthroscopy 2024:S0749-8063(24)00297-4. [PMID: 38880182 DOI: 10.1016/j.arthro.2024.03.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 03/10/2024] [Accepted: 03/27/2024] [Indexed: 06/18/2024]
Abstract
PURPOSE To systematically review the literature regarding the biomechanical properties of different repair techniques and fixation methods for vertically oriented meniscal tears. METHODS Human cadaveric studies evaluating the biomechanical properties of different repair techniques for vertically oriented meniscal tears were identified using the PubMed, EMBASE, and Cumulative Index to Nursing & Allied Health databases. Primary outcomes included load to failure, displacement, stiffness, peak contact pressure, and contact area of repaired menisci. Repair techniques from included studies were reclassified into a total of 19 distinct all-inside (AI), inside-out (IO), or outside-in (OI) techniques. RESULTS Sixteen studies were included (420 total menisci). Contact pressure and area were restored to intact-state values across all 5 compressive load studies at low knee flexion angles but not at greater knee flexion angles (i.e., >60°). There were no significant differences in contact pressure or area between AI, IO, and OI techniques across all studies. Some studies demonstrated statistically significant advantages in tensile properties with IO techniques when compared with AI techniques, whereas others found AI techniques to be superior. No studies directly compared tensile properties of OI techniques with those of AI or IO techniques. Vertical mattress suture configurations resulted in significantly greater load to failure and decreased displacement compared with horizontal mattress configurations in 67% of studies comparing the 2 techniques. There was no difference in the rate of tissue failure in AI (66.97%), IO (60.38%), or OI (66.67%, χ2 = 0.83, P = .66) techniques. CONCLUSIONS Contact mechanics are reliably restored after repair of vertical meniscal tears at low flexion angles but inconsistently restored at greater flexion angles, regardless of technique. Vertical mattress configurations outperformed horizontal mattress configurations under tensile load. There are conflicting data regarding the comparison of tensile properties between AI and IO techniques. Ultimately, neither AI, IO, nor OI repair demonstrated superior biomechanical properties in the present literature. CLINICAL RELEVANCE Several repair techniques demonstrate favorable biomechanical properties for vertical meniscal tears under tensile and compressive loads. Neither AI, IO, nor OI repair techniques demonstrate superior biomechanical properties at this time.
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Affiliation(s)
- Sohil S Desai
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, New York, U.S.A..
| | - Natalia Czerwonka
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, New York, U.S.A
| | - Omar Farah
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, U.S.A
| | - R Alex Ruberto
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, U.S.A
| | - John D Mueller
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, New York, U.S.A
| | - Xavier Ferrer
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, New York, U.S.A
| | - Jorge Chahla
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - David P Trofa
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, New York, U.S.A
| | - Hasani W Swindell
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, New York, U.S.A
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Barber FA, Davidson PA, Henninger HB. Biomechanical Characteristics of All-Suture Meniscal Repair Devices Compared With PEEK-Anchored Devices and Inside-Out Suture for Meniscal Repair: A Porcine Study. Orthop J Sports Med 2024; 12:23259671241245127. [PMID: 38799548 PMCID: PMC11128174 DOI: 10.1177/23259671241245127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 10/11/2023] [Indexed: 05/29/2024] Open
Abstract
Background Recently, all-suture, all-inside meniscal repair devices-including devices containing flat sutures or tapes-have been introduced. Similar to those in suture anchors, these modifications may have different performance characteristics than conventional sutures and polyether ether ketone (PEEK)-anchored devices. Purpose To compare the biomechanical characteristics of all-suture meniscal repair devices with those of a conventional PEEK-anchored device and an inside-out meniscal suture construct. Study Design Controlled laboratory study. Methods A total of 48 adult porcine menisci with simulated bucket-handle tears were included. Single-device repairs were performed with the SuperBall Meniscal Repair System, FiberStitch, and FAST-FIX 360 with 2 PEEK anchors, and a vertical mattress inside-out suture repair was performed using a Ti-Cron No. 2-0 braided polyethylene terephthalate suture. All specimens were preloaded (10 N) and cycled 200 times (between 10 and 50 N). Specimens surviving cyclic loading were then destructively tested. Endpoints included maximum failure load, stiffness, cyclic displacement, and failure mode. The goal was 12 successful tests in each group. Metrics between groups were compared using analysis of variance with post hoc tests to control for multiple comparisons. Results The SuperBall (108.9 N) was significantly stronger than the FAST-FIX 360 (67.3 N) and Ti-Cron (75.2 N), and the FiberStitch (102.8 N) was significantly stronger than the FAST-FIX 360 (P≤ .01 for all). Cyclic stiffness increased during cyclic loading for all constructs (P < .001). The Ti-Cron was significantly stiffer than the SuperBall during 5 to 200 cycles (P < .001). Cyclic displacement significantly increased in all constructs during cycling (P < .001) but did not differ between devices. Failure mode varied by device: the Ti-Cron repairs failed because of suture breakage, the SuperBall and FAST-FIX 360 failed at the anchor, and the FiberStitch showed both failure modes. Conclusion The all-suture, all-inside meniscal repair devices demonstrated superior strength to the PEEK-anchored device and the classic inside-out suture meniscal repair but no statistically significant difference in cyclic displacement.
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Affiliation(s)
- F. Alan Barber
- Plano Orthopedic and Sports Medicine Center, Plano, Texas, USA
| | | | - Heath B. Henninger
- Orthopaedic Research Laboratory, University of Utah, Salt Lake City, Utah, USA
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Massey PA, Scalisi W, Montgomery C, Daily D, Robinson J, Solitro GF. Biomechanical Comparison of All-Suture, All-Inside Meniscus Repair Devices in a Human Cadaveric Meniscus Model. Cartilage 2024:19476035241234315. [PMID: 38426452 DOI: 10.1177/19476035241234315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVE Newer all-suture, all-inside meniscus repair devices utilize soft suture anchors. The purpose of this study was to compare the biomechanical performance of 4 meniscus repair devices in human cadaver menisci: the JuggerStitch (all-suture, all-inside), the FiberStitch (all-suture, all-inside), a polyether ether ketone (PEEK) all-inside, and an inside-out device. DESIGN Forty human cadaver menisci were tested after creating 20 mm longitudinal tears in the posterior meniscus. Each knee was randomized to 1 of 4 meniscus repair groups: JuggerStitch (all-suture, all-inside), FiberStitch (all-suture, all-inside), FAST-FIX 360 (PEEK-based anchor all-inside), and inside-out (with BroadbandTM tape meniscus needles). For each meniscus, 2 devices were used to prepare vertical mattress repair construct. The specimens were tested by pre-conditioning 20 cycles between 5 N and 30 N and then the tear diastasis was measured, followed by distraction to failure phase after imposing a displacement at a rate of 0.5 mm/s. RESULTS Ten menisci were tested in each of the 4 groups. After pre-conditioning, there was no significant difference in the gap formation among groups (P = 0.212). The average failure load for the JuggerStitch, FiberStitch, PEEK all-inside, and inside-out was 384 N, 311 N, 207 N, and 261 N, respectively, with a significant difference between groups (P = 0.034). Post hoc analysis showed the JuggerStitch failure load was higher than the PEEK all-inside and inside-out (P = 0.005, and P = 0.045, respectively). There was no significant difference between the failure load of the JuggerStitch and FiberStitch (P = 0.225). CONCLUSION The JuggerStitch all-suture device, FiberStitch all-suture device, PEEK all-inside, and inside-out devices have similar biomechanical properties for gapping and stiffness. The JuggerStitch all-suture, all-inside device has superior failure load compared with the PEEK all-inside and inside-out repair for longitudinal meniscus tear repair.
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Affiliation(s)
- Patrick A Massey
- Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA
| | - Wayne Scalisi
- Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA
| | - Carver Montgomery
- Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA
| | - Drayton Daily
- Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA
| | - James Robinson
- Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA
| | - Giovanni F Solitro
- Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA
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Rocha de Faria JL, Santos APG, Pavão DM, Radulski M, Leal AC, More ADO, Mozella ADP, Guimarães JAM, LaPrade RF, Roesler CRDM, Salim R. Continuous Vertical Inside-Out Versus Traditional Vertical Inside-Out Meniscal Repair: A Biomechanical Comparison. Orthop J Sports Med 2023; 11:23259671231209951. [PMID: 38021309 PMCID: PMC10644761 DOI: 10.1177/23259671231209951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 06/02/2023] [Indexed: 12/01/2023] Open
Abstract
Background Biomechanical assessment of meniscal repairs is essential for evaluating different meniscal suturing methods and techniques. The continuous meniscal suture technique is a newer method of meniscal repair that may have biomechanical differences compared with traditional techniques. Purpose To evaluate the displacement, stiffness after cyclical loading, and load to failure for a continuous vertical inside-out meniscal suture versus a traditional vertical inside-out meniscal suture in a porcine medial meniscus. Study Design Controlled laboratory study. Methods A total of 28 porcine knees were acquired and divided into 2 test groups of 14 medial meniscus each. A 2.0-cm longitudinal red-white zone cut was made in the body of the medial meniscus for each knee. The continuous suture (CS) group received 4 vertical stitches performed with a continuous vertical meniscal suture technique, and the inside-out suture (IO) group received a traditional vertical suture with 4 stitches. Two traction tapes were passed between the sutures and positioned in the biomechanical testing fixture device. Each specimen underwent load-to-failure testing at 5 mm/s, and displacement, system stiffness, and maximum load to failure were compared between the groups. Results The displacement after the cyclic test was 0.53 ± 0.12 and 0.48 ± 0.07 mm for the CS and IO groups, respectively. There was no significant difference between the groups (P = .2792). The stiffness at the ultimate load testing was 36.3 ± 1.9 and 35.3 ± 2.4 N/mm for groups CS and IO, respectively, with no significant difference between the groups (P = .2557). In the load-to-failure test, the ultimate load was 218.2 ± 63.9 and 238.3 ± 71.3 N in the CS and IO groups, respectively, with no significant group differences (P = .3062). Conclusion A continuous vertical meniscal suture created a configuration for treating longitudinal meniscal lesions that was beneficial and biomechanically similar to a traditional vertical suture technique. Clinical Relevance The study findings indicate that use of the continuous vertical inside-out meniscal suture technique is a possible therapeutic option.
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Affiliation(s)
- José Leonardo Rocha de Faria
- Knee Surgery Center, National Institute of Traumatology and Orthopedics (INTO), Rio de Janeiro, Brazil
- School of Medicine from University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil
| | - Arthur Paiva Grimaldi Santos
- Biomechanical Engineering Laboratory of Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Douglas Mello Pavão
- Knee Surgery Center, National Institute of Traumatology and Orthopedics (INTO), Rio de Janeiro, Brazil
- School of Medicine from University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil
| | - Mariana Radulski
- Medical School of Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Ana Carolina Leal
- Research Division, National Institute of Traumatology and Orthopedics (INTO), Rio de Janeiro, Brazil
| | - Ari Digiácomo Ocampo More
- Biomechanical Engineering Laboratory of Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
- Medical School of Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Alan de Paula Mozella
- Knee Surgery Center, National Institute of Traumatology and Orthopedics (INTO), Rio de Janeiro, Brazil
- School of Medicine from University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil
| | | | - Robert F LaPrade
- Twin Cities Orthopaedics, Edina, Minnesota, USA
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | | | - Rodrigo Salim
- School of Medicine from University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil
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Deep flexion helps to avoid popliteal artery injury during all-inside lateral meniscal repair: A cadaveric study. Knee 2021; 33:159-168. [PMID: 34624750 DOI: 10.1016/j.knee.2021.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 07/09/2021] [Accepted: 09/09/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Arthroscopic meniscus repair rarely leads to major complications such as popliteal artery injury. The distance between the suturing device and the popliteal artery, and the risk of popliteal artery injury at different knee flexion angles during all-inside lateral meniscal repair remain unclear. METHODS All-inside devices were inserted into 10 human cadaveric knees at the posterior horn of the lateral meniscus through the anterolateral portal at 60°, 90°, and 120° knee flexion; posterior segment of the lateral meniscus through the anterolateral portal at 60°, 90°, and 120°; and anteromedial portal at 90°. Distance and positional relationship between the device and popliteal artery were measured radiographically. RESULTS In posterior horn repair through the anterolateral portal, the median distance increased from 5.7 mm at 60° to 9.1 mm at 90° (P = 0.63) and 18.0 mm at 120° (P = 0.02). The device pushed the wire at 60° in three cases, 90° in one case, and 120° in 0 cases. In posterior segment repair through the anterolateral portal, the median distance was 12.6 mm at 60°, 10.4 mm at 90°, and 18.3 mm at 120° (P = 0.08). The median distance at 90° was 18.1 mm through the anteromedial portal, the same as that at 120° through the anterolateral portal (P = 0.43), but greater than that at 90° through the anterolateral portal (P = 0.04). The wire was not pushed in any case. CONCLUSION Although all-inside repair of the posterior part of the lateral meniscus through the anterolateral portal is risky, deeper knee flexion reduces the risk of popliteal artery injury.
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Yamakawa S, Mae T, Ogasawara I, Hirose T, Konda S, Nakata K. Placement of sutures for inside-out meniscal repair: both sutures through meniscal tissue reduces displacement on cyclical loading. J Exp Orthop 2021; 8:94. [PMID: 34676462 PMCID: PMC8531164 DOI: 10.1186/s40634-021-00417-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/13/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose The 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. Methods Twenty-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. Results In 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. Conclusion The 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 relevance In the inside-out meniscal repair, the outer suture should be inserted into the remaining peripheral meniscus or the capsule near the meniscus.
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Affiliation(s)
- Satoshi Yamakawa
- Department of Sports Medical Biomechanics, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Tatsuo Mae
- Department of Sports Medical Biomechanics, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan.
| | - Issei Ogasawara
- Department of Sports Medical Biomechanics, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan.,Department of Health and Sport Sciences, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Takehito Hirose
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Shoji Konda
- Department of Sports Medical Biomechanics, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan.,Department of Health and Sport Sciences, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Ken Nakata
- Department of Health and Sport Sciences, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Teng Y, Zhang X, Da L, Hu J, Wang H, Han H, Wu M, Zhang S, Xia Y. Whether sutures reduce the graft laceration caused by interference screw in anterior cruciate ligament reconstruction? A biomechanical study in vitro. BMC Musculoskelet Disord 2021; 22:571. [PMID: 34158018 PMCID: PMC8218482 DOI: 10.1186/s12891-021-04457-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/10/2021] [Indexed: 12/02/2022] Open
Abstract
Background Interference screw is commonly used for graft fixation in anterior cruciate ligament (ACL) reconstruction. However, previous studies had reported that the insertion of interference screws significantly caused graft laceration. The purposes of this study were to (1) quantitatively evaluate the graft laceration from one single insertion of PEEK interference screws; and (2) determine whether different types of sutures reduced the graft laceration after one single insertion of interference screws in ACL reconstruction. Methods The in-vitro ACL reconstruction model was created using porcine tibias and bovine extensor digitorum tendons of bovine hind limbs. The ends of grafts were sutured using three different sutures, including the bioabsorbable, Ethibond and ultra-high molecular weight polyethylene (UHMWPE) sutures. Poly-ether-ether-ketone (PEEK) interference screws were used for tibial fixation. This study was divided into five groups (n = 10 in each group): the non-fixed group, the non-sutured group, the absorbable suture group, the Ethibond suture group and the UHMWPE suture group. Biomechanical tests were performed using the mode of pull-to-failure loading tests at 10 mm/min. Tensile stiffness (newtons per millimeter), energy absorbed to failure (in joules) and ultimate load (newtons) were recorded for analysis. Results All prepared tendons and bone specimens showed similar characteristics (length, weight, and pre-tension of the tendons, tibial bone mineral density) among all groups (P > 0.05). The biomechanical tests demonstrated that PEEK interference screws significantly caused the graft laceration (P < 0.05). However, all sutures (the bioabsorbable, Ethibond and UHMWPE sutures) did not reduce the graft laceration in ACL reconstruction (P > 0.05). Conclusions Our biomechanical study suggested that the ultimate failure load of grafts was reduced of approximately 25 % after one single insertion of a PEEK interference screw in ACL reconstruction. Suturing the ends of the grafts using different sutures (absorbable, Ethibond and UHMWPE sutures) did not decrease the graft laceration caused by interference screws.
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Affiliation(s)
- Yuanjun Teng
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou University, No. 82 Cuiyingmen, Chengguan District, 730030, Lanzhou City, Gansu Province, People's Republic of China.,Orthopaedics Key Laboratory of Gansu Province, Lanzhou University Second Hospital, Lanzhou University, 730030, Lanzhou City, Gansu Province, People's Republic of China
| | - Xiaohui Zhang
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou University, No. 82 Cuiyingmen, Chengguan District, 730030, Lanzhou City, Gansu Province, People's Republic of China
| | - Lijun Da
- Department of Oncology, Lanzhou University Second Hospital, Lanzhou University, 730030, Lanzhou City, Gansu Province, People's Republic of China
| | - Jie Hu
- The Second Clinical Medical College, Lanzhou University, 730030, Lanzhou City, Gansu Province, People's Republic of China
| | - Hong Wang
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou University, No. 82 Cuiyingmen, Chengguan District, 730030, Lanzhou City, Gansu Province, People's Republic of China.,Orthopaedics Key Laboratory of Gansu Province, Lanzhou University Second Hospital, Lanzhou University, 730030, Lanzhou City, Gansu Province, People's Republic of China
| | - Hua Han
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou University, No. 82 Cuiyingmen, Chengguan District, 730030, Lanzhou City, Gansu Province, People's Republic of China
| | - Meng Wu
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou University, No. 82 Cuiyingmen, Chengguan District, 730030, Lanzhou City, Gansu Province, People's Republic of China
| | - Shifeng Zhang
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou University, No. 82 Cuiyingmen, Chengguan District, 730030, Lanzhou City, Gansu Province, People's Republic of China
| | - Yayi Xia
- Department of Orthopaedics, Lanzhou University Second Hospital, Lanzhou University, No. 82 Cuiyingmen, Chengguan District, 730030, Lanzhou City, Gansu Province, People's Republic of China. .,Orthopaedics Key Laboratory of Gansu Province, Lanzhou University Second Hospital, Lanzhou University, 730030, Lanzhou City, Gansu Province, People's Republic of China.
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Müller S, Schwenk T, de Wild M, Dimitriou D, Rosso C. Increased Construct Stiffness With Meniscal Repair Sutures and Devices Increases the Risk of Cheese-Wiring During Biomechanical Load-to-Failure Testing. Orthop J Sports Med 2021; 9:23259671211015674. [PMID: 34189149 PMCID: PMC8209834 DOI: 10.1177/23259671211015674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 04/14/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Cheese-wiring, the suture that cuts through the meniscus, is a well-known issue in meniscal repair. So far, contributing factors are neither fully understood nor sufficiently studied. Hypothesis/Purpose: To investigate whether the construct stiffness of repair sutures and devices correlates with suture cut-through (cheese-wiring) during load-to-failure testing. Study Design: Controlled laboratory study. Methods: In 131 porcine menisci, longitudinal bucket-handle tears were repaired using either inside-out sutures (n = 66; No. 0 Ultrabraid, 2-0 Orthocord, 2-0 FiberWire, and 2-0 Ethibond) or all-inside devices (n = 65; FastFix360, Omnispan, and Meniscal Cinch). After cyclic loading, load-to-failure testing was performed. The mode of failure and construct stiffness were recorded. A receiver operating characteristic curve analysis was performed to define the optimal stiffness threshold for predicting meniscal repair failure by cheese-wiring. The 2-tailed t test and analysis of variance were used to test significance. Results: Loss of suture fixation was the most common mode of failure in all specimens (58%), except for the Omnispan, which failed most commonly because of anchor pull-through. The Omnispan demonstrated the highest construct stiffness (30.8 ± 3.5 N/mm), whereas the Meniscal Cinch (18.0 ± 8.8 N/mm) and Ethibond (19.4 ± 7.8 N/mm) demonstrated the lowest construct stiffness. The Omnispan showed significantly higher stiffness compared with the Meniscal Cinch (P < .001) and Ethibond (P = .02), whereas the stiffness of the Meniscal Cinch was significantly lower compared with that of the FiberWire (P = .01), Ultrabraid (P = .04), and FastFix360 (P = .03). While meniscal repair with a high construct stiffness more often failed by cheese-wiring, meniscal repair with a lower stiffness failed by loss of suture fixation, knot slippage, or anchor pull-through. Meniscal repair with a stiffness >26.5 N/mm had a 3.6 times higher risk of failure due to cheese-wiring during load-to-failure testing (95% CI, 1.4-8.2; P < .0001). Conclusion: Meniscal repair using inside-out sutures and all-inside devices with a higher construct stiffness (>26.5 N/mm) was more likely to fail through suture cut-through (cheese-wiring) than that with a lower stiffness (≤26.5 N/mm). Clinical Relevance: This is the first study investigating the impact of construct stiffness on meniscal repair failure by suture cut-through (cheese-wiring).
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Affiliation(s)
- Sebastian Müller
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Tanja Schwenk
- University of Basel, Basel, Switzerland.,Department of Medical Oncology, Kantonsspital Aarau, Aarau, Switzerland
| | - Michael de Wild
- Institute for Medical Engineering and Medical Informatics, School of Life Sciences, University of Applied Sciences and Arts Northwestern Switzerland, Muttenz, Switzerland
| | - Dimitris Dimitriou
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Claudio Rosso
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland.,Shoulder and Elbow Unit, ARTHRO Medics, Basel, Switzerland
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Turcotte JJ, Maley AD, Levermore SB, Petre BM, Redziniak DE. Risk factors for all-inside meniscal repair failure in isolation and in conjunction with anterior cruciate ligament reconstruction. Knee 2021; 28:9-16. [PMID: 33278740 DOI: 10.1016/j.knee.2020.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/11/2020] [Accepted: 10/18/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND This study examines the relationship between meniscus tear presentations and failure rates following all-inside repair in isolation and in conjunction with an anterior cruciate ligament (ACL) reconstruction. METHODS Eighty seven consecutive patients undergoing all-inside meniscal repair at a single institution from July 2016 to June 2018 were retrospectively reviewed. Details of patient presentation, tear type and location, the presence or absence of simultaneous ACL reconstruction, and surgical repair details were recorded to evaluate the relationship between patient characteristics and the primary endpoint of repair failure. RESULTS Patients were followed for an average of 2.7 ± 0.8 years. Three patients (3.4%) experienced 30-day complications including 1 deep vein thrombosis and 2 joint aspirations. Within the study time frame, 15 repairs (17.2%) failed, with 10 (11.5%) failing within one year of the initial procedure; the average time to failure was 12.3 ± 9.0 months. Patients undergoing concurrent ACL reconstruction were less likely to experience repair failure (9.7% vs. 36.0%, p = .009), while bucket-handle repairs were more likely to fail during the study period (45.0% vs. 9.0%, p = .001). These trends remained after controlling for tear location, body mass index, and number of sutures (ACL reconstruction Odds Ratio [OR]: 0.229, p = .029; Bucket-handle OR: 9.400, p = .003). CONCLUSION Our findings suggest concurrent ACL reconstruction at the time of meniscal repair is associated with increased repair survival. The all-inside technique may be successfully used across a variety of tear types and locations, although further study of its efficacy in repairing bucket-handle tears is warranted.
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Affiliation(s)
- Justin J Turcotte
- Anne Arundel Medical Center Orthopedics, 2000 Medical Parkway, Suite 101, Annapolis, MD 21401, United States.
| | - Alyssa D Maley
- Anne Arundel Medical Center Orthopedics, 2000 Medical Parkway, Suite 101, Annapolis, MD 21401, United States
| | - Sandra B Levermore
- Anne Arundel Medical Center Orthopedics, 2000 Medical Parkway, Suite 101, Annapolis, MD 21401, United States
| | - Benjamin M Petre
- Anne Arundel Medical Center Orthopedics, 2000 Medical Parkway, Suite 101, Annapolis, MD 21401, United States
| | - Daniel E Redziniak
- Anne Arundel Medical Center Orthopedics, 2000 Medical Parkway, Suite 101, Annapolis, MD 21401, United States
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Barber FA, Howard MS, Ashraf W, Spenciner DB. The Biomechanical Performance of the Latest All-Inside Meniscal Repair Devices. Arthroscopy 2020; 36:3001-3007. [PMID: 32315765 DOI: 10.1016/j.arthro.2020.03.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 03/16/2020] [Accepted: 03/25/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the biomechanical characteristics of recently introduced meniscal repair devices with a hand-tied, inside-out meniscal suture in a human meniscus model. METHODS In detached adult human menisci, vertical longitudinal cuts were created 3 mm from the synovial-meniscal junction, simulating a bucket-handle meniscal tear. Each cut was repaired using a single device. Group 1 received a vertical mattress suture of No. 2-0 OrthoCord; group 2, TrueSpan device with PEEK (polyether ether ketone) anchors containing No. 2-0 OrthoCord suture; group 3, TrueSpan device with biodegradable poly-lactide-co-glycolide (PLGA) anchors containing No. 2-0 OrthoCord suture; group 4, Meniscal Cinch II device; group 5, AIR meniscal repair device; and group 6, FasT-Fix 360 device. All samples were preloaded at 5 N and cycled 200 times between 5 and 20 N. The specimens that survived cyclic loading were destructively tested at 12.5 mm/s. Endpoints included maximum load, displacement, stiffness, and failure mode. RESULTS The mean failure loads were as follows: 95.8 N for OrthoCord suture, 87.1 N for TrueSpan with PEEK, 84.6 N for TrueSpan with PLGA, 48.6 N for Meniscal Cinch II, 72.3 N for AIR, and 68.1 N for FasT-Fix 360. Repairs performed with OrthoCord suture (P = .002) and both TrueSpan devices (P < .03) but not the FasT-Fix 360 device or AIR device were statistically significantly stronger than Meniscal Cinch II repairs. Mean cyclic displacement measured 1.1 mm for OrthoCord, 1.5 mm for TrueSpan with PEEK, 1.5 mm for TrueSpan with PLGA, 2.1 mm for Meniscal Cinch II, 1.1 mm for AIR, and 1.4 mm for FasT-Fix 360. The Meniscal Cinch II device showed more displacement than all other devices (P < .05). The FasT-Fix 360, AIR, and Meniscal Cinch II devices failed by anchor pullout from the peripheral meniscus. OrthoCord and both TrueSpan devices failed by suture pulling through the bucket-handle tissue. CONCLUSIONS OrthoCord suture is stronger than the AIR, FasT-Fix 360, and Meniscal Cinch II devices. The TrueSpan device with PEEK and TrueSpan device with PLGA are stronger than the Meniscal Cinch II device. The Meniscal Cinch II device failed during cyclic loading with greater cyclic displacement than the AIR device, FasT-Fix 360 device, OrthoCord, and TrueSpan device with PEEK. The Meniscal Cinch II, AIR, and FasT-Fix 360 devices failed by anchor pullout, whereas OrthoCord and both TrueSpan devices failed by suture pull-through. CLINICAL RELEVANCE Some newly introduced all-inside meniscal repair devices show inferior failure strength compared with earlier versions that might adversely impact clinical outcomes.
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Affiliation(s)
- F Alan Barber
- Plano Orthopedic Sports Medicine Center, Plano, Texas, U.S.A
| | | | - Wasik Ashraf
- Crystal Run Healthcare, New Windsor, New York, U.S.A
| | - David B Spenciner
- DePuy Synthes Mitek Sports Medicine, Raynham, Massachusetts, U.S.A.; Rensselaer Polytechnic Institute, Troy, New York, U.S.A
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The all-inside all-suture technique demonstrated better biomechanical behaviors in meniscus radial tear repair. Knee Surg Sports Traumatol Arthrosc 2020; 28:3606-3612. [PMID: 32514843 DOI: 10.1007/s00167-020-06078-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 05/20/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the effectiveness of three constructs and techniques for repair of radial tears of the meniscus. METHODS Thirty fresh frozen porcine menisci were divided equally into three groups consisting of (1) inside-out repair group, (2) a commonly used all-inside suture with anchor hybrid repair construct (AISAH) (Meniscal Cinch™), and (3) an all-inside all-suture repair construct (AIAS) (Knee Scorpion™). Radial tears were created and repaired and then the menisci were secured to the materials testing machine. Both cyclic loading and load-to-failure testing were performed. The displacement, stiffness, response to cyclic loading, and mode of failure were recorded and analyzed statistically. RESULTS The displacement after cyclic loading (DACL) of the Cinch repair construct group was significantly higher than that of the inside-out repair construct group (p = 0.000) and AIAS repair construct (p = 0.000). There was not a statistical difference of DACL between inside-out and AIAS groups (n.s.). The inside-out construct failed at a significantly higher load than the AISAH repair construct (p = 0.000) and AIAS construct (p = 0.006). The AIAS construct failed at a significantly higher load than the AISAH repair construct (p = 0.009). The AIAS had a higher stiffness than AISAH (p = 0.047). The AIAS had a higher load at 3 mm protrusion than AISAH (p = 0.034). CONCLUSION The AIAS repair construct had better biomechanical behaviors than AISAH construct and inside-out repair technique. Inside-out sutures and AIAS repair construct had similar biomechanical responses to cyclic loading. The AIAS can be used for meniscus tear surgical repair with less damage to peri-meniscus tissues.
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Hang G, Yew AKS, Chou SM, Wong YR, Tay SC, Lie DTT. Biomechanical comparison of vertical suture techniques for repairing radial meniscus tear. J Exp Orthop 2020; 7:77. [PMID: 33025241 PMCID: PMC7538523 DOI: 10.1186/s40634-020-00296-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/24/2020] [Indexed: 02/07/2023] Open
Abstract
Purpose The 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. Methods Thirty-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. Results Group 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. Conclusion Our 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.
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Affiliation(s)
- Guanqi Hang
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Singapore, 169865, Singapore.
| | - Andy Khye Soon Yew
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Singapore, 169865, Singapore
| | - Siaw Meng Chou
- School of Mechanical & Aerospace Engineering, College of Engineering, Nanyang Technological University, 50 Nanyang Ave, Singapore, 639798, Singapore
| | - Yoke Rung Wong
- Department of Hand Surgery, Singapore General Hospital, 20 College Road, Singapore, 169865, Singapore
| | - Shian Chao Tay
- Department of Hand Surgery, Singapore General Hospital, 20 College Road, Singapore, 169865, Singapore
| | - Denny Tijauw Tjoen Lie
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Singapore, 169865, Singapore
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Rodríguez-Roiz JM, Sastre-Solsona S, Popescu D, Montañana-Burillo J, Combalia-Aleu A. The relationship between ACL reconstruction and meniscal repair: quality of life, sports return, and meniscal failure rate-2- to 12-year follow-up. J Orthop Surg Res 2020; 15:361. [PMID: 32854749 PMCID: PMC7450795 DOI: 10.1186/s13018-020-01878-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/11/2020] [Indexed: 01/14/2023] Open
Abstract
Background Few studies have approached in a long-term follow-up of meniscal repair at an amateur level, specially studying variables as a quality of life and failure rate. The purpose of this review is to study medium to long-term clinical results in patients at amateur sports patients, that have required meniscal sutures at our center, with or without ACL reconstruction. We evaluate the objective function of the knee, as well as patients’ return to sports activities, quality of life, and the rate of failed repair and study of the possible reasons. Methods This was an observational retrospective study. Ninety-two patients who regularly perform amateur sports activities (Tegner 4 to 7) were assessed, with a minimum follow-up period of 2 years, divided into 2 groups: group 1, isolated meniscal suture (43 cases) and group 2, associated to ACL reconstruction (49 cases). Each patient made this test in 2019: Lysholm and Tegner (validated for Spanish) before a knee injury and after surgery, motivation to return to sports activity (Likert scale with 3 items: low, regular, or high), and quality of life through SD-12 test. Results High return to amateur sports rate (92%) was even higher in the isolated meniscal repair group in comparison to the group with associated ACL. We have not found statistically significant differences between sports return and age, gender, injured meniscus, chondral injuries, preoperative Tegner score, or motivation. No significant differences in physical or mental health fields between both groups. Meniscal repair failed in 12 patients (13%). Higher rate of failure in isolated bucket-handle tear injuries (p < 0.0062). No statistically significant association was found between the other variables studied. Conclusions Good results with 92% of sports return, low rate of complications, and low retear rate, even lower when is associated with ACL reconstruction and in external meniscus repair, and high values at SF-12 between 2 groups.
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Affiliation(s)
- Juan M Rodríguez-Roiz
- Orthopedic & Trauma Surgery Dept, Hospital Clínic, C/Villarroel 170, 08036, Barcelona, Spain. .,CLINICA SAGRADA FAMILIA BARCELONA, c/torras i pujalt 1, 08022, Barcelona, Spain.
| | - Sergi Sastre-Solsona
- Orthopedic & Trauma Surgery Dept, Hospital Clínic, C/Villarroel 170, 08036, Barcelona, Spain
| | - Dragos Popescu
- Orthopedic & Trauma Surgery Dept, Hospital Clínic, C/Villarroel 170, 08036, Barcelona, Spain
| | - Jordi Montañana-Burillo
- Orthopedic & Trauma Surgery Dept, Hospital Clínic, C/Villarroel 170, 08036, Barcelona, Spain
| | - Andres Combalia-Aleu
- Orthopedic & Trauma Surgery Dept, Hospital Clínic, C/Villarroel 170, 08036, Barcelona, Spain
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Nakanishi Y, Hoshino Y, Nagamune K, Yamamoto T, Nagai K, Araki D, Kanzaki N, Matsushita T, Kuroda R. Radial Meniscal Tears Are Best Repaired by a Modified "Cross" Tie-Grip Suture Based on a Biomechanical Comparison of 4 Repair Techniques in a Porcine Model. Orthop J Sports Med 2020; 8:2325967120935810. [PMID: 32728592 PMCID: PMC7366409 DOI: 10.1177/2325967120935810] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 12/23/2019] [Indexed: 11/16/2022] Open
Abstract
Background: The tie-grip suture can fix radial tears more rigidly than simple conventional sutures. However, one shortcoming is the residual gap at the central margin of the tear. The tie-grip suture was modified to address this issue and named the “cross tie-grip suture.” Purpose/Hypothesis: The purpose of this study was to compare the suture stability and strength among 4 suturing techniques: the original tie-grip, cross tie-grip, and 2 conventional sutures (double horizontal and cross). It was hypothesized that the cross tie-grip suture would show the least displacement and resist the greatest maximum load. Study Design: Controlled laboratory study. Methods: A total of 40 fresh-frozen porcine knees were dissected to acquire 80 menisci; 20 menisci were tested in each suture group. A radial tear was created at the middle third of the meniscal body. Repair was performed with the following: original tie-grip, cross tie-grip, double horizontal, and cross sutures. The mechanical strength of sutured menisci was evaluated using a tensile testing machine. All menisci underwent submaximal loading and load to failure. The gap distance and ultimate failure load were compared using analysis of variance. The failure mode was recorded after load-to-failure testing. Results: Displacement after 500 cycles was significantly smaller in the cross tie-grip group (0.4 ± 0.3 mm) compared with the tie-grip (0.9 ± 0.6 mm), double horizontal (1.2 ± 0.7 mm), and cross suture groups (1.4 ± 0.6 mm) (P < .05). The ultimate failure load was significantly greater in the cross tie-grip (154.9 ± 29.0 N) and tie-grip (145.2 ± 39.1 N) groups compared with the double horizontal (81.2 ± 19.9 N) and cross suture groups (87.3 ± 17.7 N) (P < .05). Tissue failure was the most common mode of failure in all groups. Conclusion: Upon repair of radial meniscal tears, the cross tie-grip suture showed less displacement compared with that of the tie-grip, double horizontal, and cross sutures and demonstrated equivalent load to failure to that of the tie-grip suture at time zero. Clinical Relevance: The cross tie-grip suture provided high resistance to displacement after repair of radial tears and may be advantageous in healing for radial meniscal tears.
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Affiliation(s)
- Yuta Nakanishi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuichi Hoshino
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kouki Nagamune
- Department of Human and Artificial Intelligent Systems, Graduate School of Engineering, University of Fukui, Fukui, Japan
| | - Tetsuya Yamamoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kanto Nagai
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Daisuke Araki
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Noriyuki Kanzaki
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takehiko Matsushita
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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In- vitro evaluation of the bioactivity and the biocompatibility of a novel coated UHMWPE biomaterial for biomedical applications. J Mech Behav Biomed Mater 2020; 101:103409. [DOI: 10.1016/j.jmbbm.2019.103409] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 08/22/2019] [Accepted: 08/26/2019] [Indexed: 11/15/2022]
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Influence of Sutures on Cartilage Integrity: Do Meniscus Sutures Harm Cartilage? An Experimental Animal Study. Arthroscopy 2019; 35:1509-1516. [PMID: 30745024 DOI: 10.1016/j.arthro.2018.11.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 11/11/2018] [Accepted: 11/14/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate whether different suture materials in meniscal repair may harm cartilage. METHODS A preloaded linear friction testing setup including porcine knees with porcine cartilage, porcine meniscus, and different suture materials (braided nonabsorbable, absorbable monofilament) was used. Five groups with different tribological pairs were tested: cartilage on meniscus (control), cartilage on cartilage (control No. 2), and cartilage on different meniscus sutures (3 groups). Cartilage integrity was analyzed macroscopically by the India ink method and histologically using Giemsa-eosin-stained undecalcified methyl methacrylate sections. Cartilage lesions were classified by using a quantitative scoring system. RESULTS The control groups did not show cartilage damage, either macroscopically or histologically. Loading cartilage with sutured menisci led to significant damage of the superficial radial and transitional zones with braided nonabsorbable (P = .03) and absorbable monofilament (P = .02) sutures at final examination. Menisci sutured with braided nonabsorbable material resulted in deeper damage to the cartilage. However, there were no significant differences between the suture materials. Sutures oriented perpendicular to surface motion led to a larger defect than parallel-oriented sutures. CONCLUSIONS Braided nonabsorbable and absorbable monofilament suture materials cause significant damage to cartilage during long-term cyclic loading in vitro. The extent of damage depends on suture orientation. CLINICAL RELEVANCE This study provides data on the extent to which different suture materials in meniscus repair may harm cartilage.
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Samuelsen BT, Johnson NR, Hevesi M, Levy BA, Dahm DL, Stuart MJ, Krych AJ. Comparative Outcomes of All-Inside Versus Inside-Out Repair of Bucket-Handle Meniscal Tears: A Propensity-Matched Analysis. Orthop J Sports Med 2018; 6:2325967118779045. [PMID: 29977943 PMCID: PMC6024537 DOI: 10.1177/2325967118779045] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: There are limited data comparing the outcomes of all-inside versus inside-out meniscal repair techniques. Purpose: To assess failure rates and clinical outcomes after the surgical repair of bucket-handle meniscal tears utilizing either an all-inside or inside-out technique. Study Design: Cohort study; Level of evidence, 3. Methods: Patients with bucket-handle meniscal tears undergoing all-inside or inside-out repair at a single institution between 2003 and 2013 were analyzed. A total of 28 mensici repaired utilizing second-generation all-inside suturing devices and 42 menisci repaired using an inside-out technique were eligible for inclusion. Rigorous propensity matching was performed on the basis of age, sex, tear laterality, rim width, and concomitant anterior cruciate ligament reconstruction (ACLR), resulting in a total of 40 patients equally distributed between the 2 repair techniques for comparison. Retear-free survival as well as preoperative and postoperative International Knee Documentation Committee (IKDC) and Tegner scores and physical examination findings were subsequently analyzed. Results: Twenty patients who underwent all-inside repair (14 male; mean age, 23.7 ± 6.7 years) were successfully propensity matched to 20 patients who underwent inside-out meniscal repair (15 male; mean age, 22.5 ± 7.6 years), with a mean retear-free follow-up of 4.4 years (range, 2.5-7.4 years). Four (20%) all-inside repairs and 4 (20%) inside-out repairs failed over the course of follow-up (P > .999), with a mean time to failure of 2.7 years (range, 1.3-4.4 years) and 5.0 years (range, 0.8-7.5 years), respectively (P = .25). Increasing patient age trended toward a decreased clinical retear rate, independent of the repair technique (hazard ratio, 0.86; P = .056). There were no significant differences in the Tegner scores, IKDC scores, or range of motion between the groups as a whole or when subcategorizing by age, sex, body mass index, tear complexity, rim width, isolated versus concomitant ACLR, or medial- versus lateral-sided repair. There were no complications in the all-inside group, while there was a 10% rate of minor complications in the inside-out group (P = .49). Conclusion: Overall, satisfactory clinical outcomes are achievable at short-term to midterm follow-up with both inside-out and all-inside repair techniques of bucket-handle meniscal tears in rigorously matched patients with similar meniscal tear patterns.
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Affiliation(s)
- Brian T Samuelsen
- Department of Orthopedic Surgery and Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Nicholas R Johnson
- Department of Orthopedic Surgery and Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Mario Hevesi
- Department of Orthopedic Surgery and Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Bruce A Levy
- Department of Orthopedic Surgery and Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Diane L Dahm
- Department of Orthopedic Surgery and Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael J Stuart
- Department of Orthopedic Surgery and Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Aaron J Krych
- Department of Orthopedic Surgery and Sports Medicine Center, Mayo Clinic, Rochester, Minnesota, USA
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Yokoi H, Mae T, Iuchi R, Take Y, Tachibana Y, Shimomura K, Ohori T, Shino K, Yoshikawa H, Nakata K. Novel flat and wide meniscal repair material improves the ultimate load of knot breakage in a porcine trans-capsular meniscal repair model. J Exp Orthop 2017; 4:41. [PMID: 29260438 PMCID: PMC5736508 DOI: 10.1186/s40634-017-0114-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 11/30/2017] [Indexed: 11/10/2022] Open
Abstract
Background In the meniscal repair procedures, a high ultimate load capacity and low cyclic creep at the repair site are favorable and lead to good biological incorporation of the tear site after surgery. Previous biomechanical tensile tests of the meniscal sutures have identified the suture knot as the weakest point. We hypothesized that the strength of a suture knot depends on the suture shape, and therefore, we compared three differently shaped suture materials composed of the same material and quantity per length. The purpose of this study was to determine whether a novel flat and wide repair material (FWRM), which consists of braided multi-threads that are cross-sectionally flat and wide, improves the ultimate load of knot breakage in a biomechanical experiment using a porcine trans-capsular meniscal repair model. Methods Eighteen fresh-frozen porcine knees (n = 6 in each group) were used. A longitudinal tear in the middle segment of the medial meniscus was created and repaired with a trans-capsular inside-out method using the following suture materials: No. 2–0 braided polyester conventional suture, hollow suture, and FWRM. After the separation of the inner segment of the meniscus with leaving, the suture stability of the repaired menisci was biomechanically analyzed with a video camera system for widening after a cyclic load between 5 and 20 N was applied 300 times. Ultimate failure load and stiffness at 5 mm/ min were also analyzed. Results We found no significant difference in suture widening after cyclic load tests [conventional suture, mean 0.51 mm (S.D. 0.39 mm); hollow suture, mean 0.23 mm (S.D. 0.11 mm); and FWRM, mean 0.54 mm (S.D. 0.08 mm)]. The failure mode in all specimens was knot breakage. Compared with those of the other groups, the ultimate failure load of FWRM was statistically significantly higher in the load-to-failure tests (conventional suture, mean 58.8 N [S.D. 8.25 N]; hollow suture, mean 79.4 N [S.D. 10.2 N]; and FWRM, mean 97.4 N [S.D. 3.65 N]; p < 0.05). Conclusion FWRM improves the ultimate load of knot breakage without altering stability. This material may contribute to safe and stable meniscus repair.
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Affiliation(s)
- Hiroyuki Yokoi
- Medicine for Sports and Performing Arts, Department of Health and Sports Science, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Tatsuo Mae
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Ryo Iuchi
- Sports Orthopaedic Surgery Center, Yukioka Hospital, 2-2-3, Ukita, Kita-ku, Osaka, Osaka, 530-0021, Japan
| | - Yasuhiro Take
- Medicine for Sports and Performing Arts, Department of Health and Sports Science, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Yuta Tachibana
- Sports Orthopaedic Surgery Center, Yukioka Hospital, 2-2-3, Ukita, Kita-ku, Osaka, Osaka, 530-0021, Japan
| | - Kazunori Shimomura
- Medicine for Sports and Performing Arts, Department of Health and Sports Science, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Tomoki Ohori
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Konsei Shino
- Sports Orthopaedic Surgery Center, Yukioka Hospital, 2-2-3, Ukita, Kita-ku, Osaka, Osaka, 530-0021, Japan
| | - Hideki Yoshikawa
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Ken Nakata
- Medicine for Sports and Performing Arts, Department of Health and Sports Science, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan.
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A novel technique for modified all-inside repair of bucket-handle meniscus tears using standard arthroscopic portals. J Orthop Surg Res 2017; 12:188. [PMID: 29202765 PMCID: PMC5715506 DOI: 10.1186/s13018-017-0692-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 11/15/2017] [Indexed: 11/12/2022] Open
Abstract
Background Bucket-handle meniscus tears (BHMT) are often displaced and unstable. The inside-out technique of repairing such tears is currently the gold standard. All-inside repair with meniscal fixators is getting increasingly popular. Shortcomings of the inside-out technique include neurovascular complications, especially saphenous nerve palsy, and retention of a non-resorbable suture which can result in discomfort to patient, granuloma formation, and a foci of infection. Hence, the purpose of this project was to innovate a novel all-inside technique to precisely reduce and fix BHMT while avoiding neurovascular complications and retention of a non-resorbable suture. Methods Routine arthroscopic portals were created on a patient’s left knee with a displaced BHMT. Through the anteromedial portal, a conjoint pseudo double lumen cannula was inserted. Two limbs of a reduction suture were passed through the cannula, one over the “femoral” surface of the meniscus, one over the “tibial” surface of the meniscus anterior to the biceps femoris tendon, with the knee flexed at 20° to avoid injury to the saphenous nerve. Suture limbs were passed out percutaneously and tensioned. Results Anatomic reduction was ensured under arthroscopic visualization with ease. All inside repair was performed using the vertical mattress suture configuration. Reduction sutures were subsequently removed by cutting flush to the skin and pulling on one suture limb. The patient was back to full activities with minimal discomfort 8 months post-operatively. Conclusion The technique described is superior to existing techniques for the following reasons: (1) Reduction of the displaced meniscal tear is “extra-meniscal,” avoiding further trauma to a damaged meniscus. (2) Tensioning of the two suture limbs created promotes better control of reduction through tensioning. (3) Risk of discomfort, infection, and neurovascular damage caused by a retained suture is reduced. (4) No additional portals/equipment is required. We encourage this novel technique to be attempted by surgeons.
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Marchetti DC, Phelps BM, Dahl KD, Slette EL, Mikula JD, Dornan GJ, Bucci G, Turnbull TL, Singleton SB. A Contact Pressure Analysis Comparing an All-Inside and Inside-Out Surgical Repair Technique for Bucket-Handle Medial Meniscus Tears. Arthroscopy 2017; 33:1840-1848. [PMID: 28754246 DOI: 10.1016/j.arthro.2017.04.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 03/24/2017] [Accepted: 04/03/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To directly compare effectiveness of the inside-out and all-inside medial meniscal repair techniques in restoring native contact area and contact pressure across the medial tibial plateau at multiple knee flexion angles. METHODS Twelve male, nonpaired (n = 12), fresh-frozen human cadaveric knees underwent a series of 5 consecutive states: (1) intact medial meniscus, (2) MCL tear and repair, (3) simulated bucket-handle longitudinal tear of the medial meniscus, (4) inside-out meniscal repair, and (5) all-inside meniscal repair. Knees were loaded with a 1,000-N axial compressive force at 5 knee flexion angles (0°, 30°, 45°, 60°, 90°), and contact area, mean contact pressure, and peak contact pressure were calculated using thin film pressure sensors. RESULTS No significant differences were observed between the inside-out and all-inside repair techniques at any flexion angle for contact area, mean contact pressure, and peak contact pressure (all P > .791). Compared with the torn meniscus state, inside-out and all-inside repair techniques resulted in increased contact area at all flexion angles (all P < .005 and all P < .037, respectively), decreased mean contact pressure at all flexion angles (all P < .007 and all P < .001, respectively) except for 0° (P = .097 and P = .39, respectively), and decreased peak contact pressure at all flexion angles (all P < .001, all P < .001, respectively) except for 0° (P = .080 and P = .544, respectively). However, there were significant differences in contact area and peak contact pressure between the intact state and inside-out technique at angles ≥45° (all P < .014 and all P < .032, respectively). Additionally, there were significant differences between the intact state and all-inside technique in contact area at 60° and 90° and peak contact pressure at 90° (both P < .005 and P = .004, respectively). Median values of intact contact area, mean contact pressure, and peak contact pressure over the tested flexion angles ranged from 498 to 561 mm2, 786 to 997 N/mm2, and 1,990 to 2,215 N/mm2, respectively. CONCLUSIONS Contact area, mean contact pressure, and peak contact pressure were not significantly different between the all-inside and inside-out repair techniques at any tested flexion angle. Both techniques adequately restored native meniscus biomechanics near an intact level. CLINICAL RELEVANCE An all-inside repair technique provided similar, native-state-restoring contact mechanics compared with an inside-out repair technique for the treatment of displaced bucket-handle tears of the medial meniscus. Thus, both techniques may adequately decrease the likelihood of cartilage degeneration.
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Affiliation(s)
| | - Brian M Phelps
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Kimi D Dahl
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Erik L Slette
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Jacob D Mikula
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Grant J Dornan
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Gabriella Bucci
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
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Iuchi R, Mae T, Shino K, Matsuo T, Yoshikawa H, Nakata K. Biomechanical testing of transcapsular meniscal repair. J Exp Orthop 2017; 4:2. [PMID: 28124287 PMCID: PMC5267586 DOI: 10.1186/s40634-017-0075-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 01/13/2017] [Indexed: 11/16/2022] Open
Abstract
Background All of previous biomechanical studies on meniscal repair have examined the meniscus itself without synovial membrane and capsule, although in the clinical setting, the meniscal repair is generally performed including capsule. Therefore, biomechanical properties of transcapsular meniscal repair are unclear. Thus, this study aimed to clarify the biomechanical properties of transcapsular meniscal repair. Methods In 70 porcine femur–medial meniscus–tibia complexes with capsules, longitudinal meniscal tears were repaired using different suture techniques (inside-out or all-inside technique), suture methods (vertical or horizontal methods), and numbers of sutures (single or double). A cyclic loading test between 5 and 20 N for 300 cycles was performed followed by a load-to-failure test. Results Tears repaired by the all-inside technique presented significantly larger widening (0.88 ± 0.38 mm) than those by the inside-out technique (0.51 ± 0.39 mm) during the cyclic loading test (P = 0.035). The horizontal suture presented significantly lower ultimate failure load (62.5 ± 15.5 N) in the all-inside technique than in the vertical suture (79.7 ± 13.0 N; P = 0.018). The stacked suture had a significantly higher failure load (104.6 ± 12.5 N) than the parallel suture (83.3 ± 12.6 N; P = 0.001). Furthermore, the double suture presented significantly higher failure loads (83.3 ± 12.6 N and 104.6 ± 20.4 N) than the single suture with both inside-out (58.8 ± 8.3 N; P = 0.001) and all-inside (79.7 ± 13.0 N; P = 0.022) techniques. Conclusions Upon comparison of the suture techniques, the inside-out technique provided a more stable fixation at the repair site than the all-inside technique during the cyclic test. Among the suture methods, the vertical suture had more desirable biomechanical properties than the horizontal suture as demonstrated by smaller widening during the cyclic test and the larger load to failure. The stacked suture created a stronger fixation than the parallel suture. In terms of the number of sutures, the double suture had superior biomechanical properties compared with the single suture.
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Affiliation(s)
- Ryo Iuchi
- Sports Orthop. Center, Yukioka Hospital, Osaka, Japan.
| | - Tatsuo Mae
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Konsei Shino
- Sports Orthop. Center, Yukioka Hospital, Osaka, Japan
| | - Tomohiko Matsuo
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hideki Yoshikawa
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Ken Nakata
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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Abstract
OBJECTIVE the menisci are easily injured and difficult to repair. The aim of this study was to analyze the current state of meniscal surgery aimed at preserving morphology and conserving the biomechanics of the knee to prevent joint degeneration. METHODOLOGY a search of the electronic medical literature database Medline was conducted, from http://www.ncbi.nlm.nih.gov/pubmed. The search was not limited by language. Candidate articles were identified by searching for those that included the keywords meniscus, surgery, suture, implant, allograft. The limits were included for clinical research and clinical trials. Basic research was not included. The studies selected were evaluated and classified in three different categories: basic science, reconstruction (suture and meniscectomy) and implants (scaffolds and allograft). RESULTS the consequences of meniscectomy performed at a young age can lead to a joint cartilage degeneration twenty years later. There are few surgical options for the repair of meniscal injuries in order both to preserve the meniscus and to ensure the long term survival of the knee joint, meniscectomy, repair, suturing the tear, or reconstruction, when a meniscal allograft or synthetic substitute is used to replace the meniscus, but the biomechanical properties of the native meniscus are not reproduced entirely by the scaffolds that exist today. CONCLUSION therapies that successfully repair or replace the meniscus are therefore likely to prevent or delay osteoarthritis progression.
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Affiliation(s)
| | - Francisco Forriol
- Department of Clínica Sciences, University San Pablo - CEU, Boadilla del Monte, Spain
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Milchteim C, Branch EA, Maughon T, Hughey J, Anz AW. Biomechanical Comparison of Parallel and Crossed Suture Repair for Longitudinal Meniscus Tears. Orthop J Sports Med 2016; 4:2325967116640263. [PMID: 27104209 PMCID: PMC4827117 DOI: 10.1177/2325967116640263] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: Longitudinal meniscus tears are commonly encountered in clinical practice. Meniscus repair devices have been previously tested and presented; however, prior studies have not evaluated repair construct designs head to head. This study compared a new-generation meniscus repair device, SpeedCinch, with a similar established device, Fast-Fix 360, and a parallel repair construct to a crossed construct. Both devices utilize self-adjusting No. 2-0 ultra–high molecular weight polyethylene (UHMWPE) and 2 polyether ether ketone (PEEK) anchors. Hypothesis: Crossed suture repair constructs have higher failure loads and stiffness compared with simple parallel constructs. The newer repair device would exhibit similar performance to an established device. Study Design: Controlled laboratory study. Methods: Sutures were placed in an open fashion into the body and posterior horn regions of the medial and lateral menisci in 16 cadaveric knees. Evaluation of 2 repair devices and 2 repair constructs created 4 groups: 2 parallel vertical sutures created with the Fast-Fix 360 (2PFF), 2 crossed vertical sutures created with the Fast-Fix 360 (2XFF), 2 parallel vertical sutures created with the SpeedCinch (2PSC), and 2 crossed vertical sutures created with the SpeedCinch (2XSC). After open placement of the repair construct, each meniscus was explanted and tested to failure on a uniaxial material testing machine. All data were checked for normality of distribution, and 1-way analysis of variance by ranks was chosen to evaluate for statistical significance of maximum failure load and stiffness between groups. Statistical significance was defined as P < .05. Results: The mean maximum failure loads ± 95% CI (range) were 89.6 ± 16.3 N (125.7-47.8 N) (2PFF), 72.1 ± 11.7 N (103.4-47.6 N) (2XFF), 71.9 ± 15.5 N (109.4-41.3 N) (2PSC), and 79.5 ± 25.4 N (119.1-30.9 N) (2XSC). Interconstruct comparison revealed no statistical difference between all 4 constructs regarding maximum failure loads (P = .49). Stiffness values were also similar, with no statistical difference on comparison (P = .28). Conclusion: Both devices in the current study had similar failure load and stiffness when 2 vertical or 2 crossed sutures were tested in cadaveric human menisci. Clinical Relevance: Simple parallel vertical sutures perform similarly to crossed suture patterns at the time of implantation.
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Affiliation(s)
- Charles Milchteim
- Andrews Research and Education Foundation, Gulf Breeze, Florida, USA
| | - Eric A Branch
- Andrews Research and Education Foundation, Gulf Breeze, Florida, USA
| | - Ty Maughon
- Andrews Research and Education Foundation, Gulf Breeze, Florida, USA
| | - Jay Hughey
- Andrews Research and Education Foundation, Gulf Breeze, Florida, USA
| | - Adam W Anz
- Andrews Research and Education Foundation, Gulf Breeze, Florida, USA
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Masoudi A, Beamer BS, Harlow ER, Manoukian OS, Walley KC, Hertz B, Haeussler C, Olson JJ, Zurakowski D, Nazarian A, Ramappa AJ, DeAngelis JP. Biomechanical evaluation of an all-inside suture-based device for repairing longitudinal meniscal tears. Arthroscopy 2015; 31:428-34. [PMID: 25442653 DOI: 10.1016/j.arthro.2014.08.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 08/15/2014] [Accepted: 08/27/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE A device for all-inside suture-based meniscal repairs has been introduced (NovoStitch; Ceterix, Menlo Park, CA) that passes the suture vertically through the meniscus, thereby encircling the tear, and does not require an additional incision or extra-capsular anchors. Our aim was to compare this all-inside suture-based repair with an inside-out suture repair and an all-inside anchor-based repair (FasT-Fix 360°; Smith & Nephew, Andover, MA). METHODS Longitudinal tears were created in 36 fresh-frozen porcine menisci. Repairs were performed using an all-inside suture-based meniscal repair device, an all-inside anchor-based repair, and an inside-out suture repair. They were tested with cyclic loading and load-to-failure testing. The displacement, response to cyclic loading (100, 300, and 500 cycles), and mode of failure were recorded. The stiffness of the constructs was calculated as well. RESULTS The all-inside suture-based repairs and the inside-out repairs showed significantly higher loads to failure than the all-inside anchor-based repairs. The stiffness values for the 3 repairs were not different. There were no differences in initial displacement. After 100, 300, and 500 cycles, the inside-out repair had higher gap formation (displacement) than the other 2 groups. Suture failure was the predominant mode of failure across all repair techniques. CONCLUSIONS The all-inside suture-based repairs and inside-out repairs did not exhibit different load-to-failure values. In addition, the all-inside suture-based repairs and the all-inside anchor-based repairs did not exhibit different displacement values during cyclic loading. CLINICAL RELEVANCE When addressing a longitudinal meniscal tear, surgeons should consider biomechanical data of various repair devices and techniques in their decision-making process to maximize the mechanical strength and healing probability of the repair.
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Affiliation(s)
- Aidin Masoudi
- Center for Advanced Orthopaedic Studies, Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Brandon S Beamer
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Ethan R Harlow
- Center for Advanced Orthopaedic Studies, Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Ohan S Manoukian
- Center for Advanced Orthopaedic Studies, Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Kempland C Walley
- Center for Advanced Orthopaedic Studies, Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Benjamin Hertz
- Center for Advanced Orthopaedic Studies, Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Claudia Haeussler
- Center for Advanced Orthopaedic Studies, Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Jeffrey J Olson
- Center for Advanced Orthopaedic Studies, Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - David Zurakowski
- Department of Anesthesiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A.; Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Ara Nazarian
- Center for Advanced Orthopaedic Studies, Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Arun J Ramappa
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Joseph P DeAngelis
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A..
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Beamer BS, Masoudi A, Walley KC, Harlow ER, Manoukian OS, Hertz B, Haeussler C, Olson JJ, Deangelis JP, Nazarian A, Ramappa AJ. Analysis of a new all-inside versus inside-out technique for repairing radial meniscal tears. Arthroscopy 2015; 31:293-8. [PMID: 25312766 DOI: 10.1016/j.arthro.2014.08.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 08/05/2014] [Accepted: 08/08/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to compare gap formation, strength, and stiffness of repaired radial tears of the meniscus treated using a new all-inside technique versus a traditional inside-out suture technique. METHODS Radial tears were created in 36 fresh-frozen porcine menisci. Repairs were performed using a novel all-inside suture-based meniscal repair device or an inside-out technique. The repairs were tested for cyclic loading and load to failure. The displacement, response to cyclic loading (100, 300, and 500 cycles), and mode of failure were recorded, and the construct's stiffness was calculated. RESULTS The all-inside repairs using the novel device resulted in a significantly lower displacement (gap formation) after 100, 300, and 500 cycles (P = .002, P = .001, and P = .001, respectively). The ultimate load to failure was significantly greater for the all-inside repairs (111.61 N v 95.01 N; P = .03). The all-inside repairs showed greater stiffness (14.53 N/mm v 11.19 N/mm; P = .02). The all-inside repairs failed most often by suture breakage (suture failure). The inside-out repairs failed most commonly when the suture pulled through the tissue (tissue failure) (P < .001). CONCLUSIONS For repair of radial tears of the meniscus, the vertical suture configuration created by the all-inside technique resulted in lower displacement, higher load to failure, and greater stiffness compared with the horizontal inside-out technique. CLINICAL RELEVANCE In a porcine specimen meniscus repair model, the biomechanical properties of a vertical all-inside technique were superior to that of a horizontal inside-out technique. Future studies of biomechanical and clinical outcomes in human meniscal repairs with this device are warranted to explore whether this repair method is valuable to clinical practice and patient outcomes.
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Affiliation(s)
- Brandon S Beamer
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Aidin Masoudi
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Kempland C Walley
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Ethan R Harlow
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Ohan S Manoukian
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Ben Hertz
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Claudia Haeussler
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Jeffrey J Olson
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Joseph P Deangelis
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Ara Nazarian
- Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A..
| | - Arun J Ramappa
- Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
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Biomechanical evaluation of different suture materials for arthroscopic transtibial pull-out repair of posterior meniscus root tears. Knee Surg Sports Traumatol Arthrosc 2015; 23:132-9. [PMID: 23999948 DOI: 10.1007/s00167-013-2656-z] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 08/24/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate the biomechanical properties of four different suture materials for arthroscopic transtibial pull-out repair of posterior meniscus root tears, with special focus on the meniscus-suture interface. METHODS Forty fresh-frozen lateral porcine menisci were used. The posterior meniscus root was sutured in a standardized fashion with a simple stitch using four different suture materials: group A, No. 2 PDS™; group B, No. 2 Ethibond™; group C, No. 2 FiberWire™; and group D, 2-mm Fibertape™. Meniscus-suture constructs were subjected to cyclic loading followed by load-to-failure testing using a servo-hydraulic material testing machine. RESULTS During cyclic loading, group D showed a significantly higher displacement after 100, 500, and 1,000 cycles compared to group A (p < 0.001, p = 0.001, and p = 0.001), and a significantly higher displacement after 100 and 500 cycles compared to group B (p = 0.010 and p = 0.045). Group C showed a significantly higher displacement compared to group A after 100 cycles (p = 0.008). The highest maximum load was observed in group D, with significant differences compared to group A (p = 0.013). Group B showed a significantly higher stiffness compared to group A (p = 0.023), and both group C and group D showed a significantly higher stiffness compared to group A and group B (p < 0.001). CONCLUSION None of the evaluated suture materials provided clearly superior properties over the others during both cyclic loading and load-to-failure testing. Based on the results of this study, FiberWire™ may be the preferred suture material for transtibial pull-out repair of posterior meniscus root tears because of comparably low displacement during cyclic loading and high values for maximum load and stiffness. In the clinical setting, FiberWire™ may improve healing rates and avoid progressive extrusion of the meniscus after transtibial pull-out repair of posterior meniscus root tears.
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Hardeman F, Corten K, Mylle M, Van Herck B, Verdonk R, Verdonk P, Bellemans J. What is the best way to fix a polyurethane meniscal scaffold? A biomechanical evaluation of different fixation modes. Knee Surg Sports Traumatol Arthrosc 2015; 23:59-64. [PMID: 23579226 DOI: 10.1007/s00167-013-2495-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 04/03/2013] [Indexed: 12/14/2022]
Abstract
PURPOSE Ingrowth of meniscal tissue into a meniscal scaffold can be optimized by securely fixing the scaffold into the meniscal remnants. The purpose of this research was to test and compare commonly used suture types and suture materials to fix a meniscal scaffold. METHODS Forty fresh porcine menisci were used. All tests used the same polyurethane-based scaffold. The load to failure of horizontal, vertical and diagonal sutures with PDS 0 and with Ethibond 0, and diagonal sutures with Ultra Fast-Fix(®) and Sequent(®) to fix a meniscal scaffold were tested. Five tests were conducted for each configuration. RESULTS All constructs failed in the scaffold at a mean pullout force of 50.6 N (SD 12.7). Inferior results were noted for vertical sutures (40.1 N, SD 6.3) compared to horizontal (49.8 N, SD 5.5, p = 0.0007) and diagonal (51.7 N, SD 15.6, p = 0.024) sutures and for Ethibond 0 (41.4 N, SD 6.2) compared to PDS 0 (51.3 N, SD 12.9, p = 0.001). When comparing the diagonal suture placements, only Ethibond 0 (42.9 N, SD 5.4) showed significantly inferior results compared to PDS 0 (60.1 N, SD 16.9, p = 0.03), Ultra Fast-Fix(®) (60.1 N, SD 9.3, p = 0.004) and Sequent(®) (65.8 N, SD 4.4, p < 0.0001). CONCLUSIONS The most common failure mode when fixing a polyurethane-based meniscal scaffold is suture pull-through of the scaffold in the distraction mode. This happens at a rather low pullout force and might preclude the use of this scaffold clinically. Vertical sutures and Ethibond 0 multifilament braided sutures fail at lower forces, and the tested commercial devices show promising results.
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Affiliation(s)
- Francois Hardeman
- Knee and Sports Traumatology Unit, Orthopaedic Department, Leuven University Hospital, Weligerveld 1, 3212, Pellenberg, Belgium,
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The concept of three-dimensional hold of both circumferential and radial collagen fibres of the meniscus. Knee Surg Sports Traumatol Arthrosc 2015; 23:20-5. [PMID: 23404512 DOI: 10.1007/s00167-013-2421-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 01/21/2013] [Indexed: 10/27/2022]
Abstract
Collagen fibres of the meniscus arrange into two main orientations: circumferential fibres parallel to the long axis of the meniscus and radial fibres perpendicular to the long axis of the meniscus. Meniscal sutures are placed either in vertical or in horizontal orientations. Vertical sutures better hold circumferential fibres because it encircles them like a rope holding a bunch of tree branches. In the same manner, horizontal sutures better hold radial fibres. The "Simplified Cruciate Suture" consists of two vertical oblique sutures. Placing two vertical sutures in an oblique orientation captures greater meniscal tissue volume, holds and grasps both circumferential and radial collagen fibres of the meniscus into a three-dimensional plane with eventual high fixation strength of the repaired meniscal tear. Simplified cruciate suture is indicated for the repair of long bucket handle tears where it is placed in the middle of the tear like an anchor, and additional vertical and horizontal sutures are placed anterior and posterior to it as needed. Level of evidence V.
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Meta-analysis on biomechanical properties of meniscus repairs: are devices better than sutures? Knee Surg Sports Traumatol Arthrosc 2015; 23:83-9. [PMID: 24841938 DOI: 10.1007/s00167-014-2966-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 03/19/2014] [Indexed: 01/14/2023]
Abstract
PURPOSE Meniscal repair devices have been extensively tested during the past decades as reported in the literature. Reviewing the different meniscal repair devices and sutures with their respective biomechanical properties. METHODS For this meta-analysis, we conducted a systematic online search using PubMed, EMBASE, CCTR, and CINAHL using the search terms Meniscus OR Meniscal AND Biomechanics AND Repair). Load-to-failure (LtF), stiffness, and cyclic outcome measures were extracted independently and in duplicate. The systematic search revealed 841 manuscripts in total. After exclusion of duplicates and irrelevant publications, 41 studies remained for final analysis. The studies were published in English and German from 1995 to 2013. Due to differing cyclic force protocols, cyclic outcomes had to be excluded. RESULTS Overall, sutures had a higher LtF [suture: 87.7 ± 0.3 N (weighted mean ± standard error), device: 56.3 ± 0.1 N] and stiffness (suture: 8.9 ± 0.04 N/mm, device: 8.6 ± 0.04 N/mm) than devices, both p < 0.05. In LfT testing, PDS 0 Vertical (145.0 ± 8.1 N), OrthoCord 2-0 (143.6 ± 11.3 N), and Ethibond No 0 Vertical (133.4 ± 7.7 N) were the strongest sutures and Meniscal Viper (140.9 ± 5.1 N), MaxFire Vertical (136.2 ± 11.3 N), and FasT-Fix Vertical (115.2 ± 1.6 N) were the strongest devices. Second-generation devices were significantly stronger and stiffer than first-generation devices (p < 0.001). CLINICAL RELEVANCE Suture repair remains the gold standard with a vertically oriented suture configuration showing superior LtF values compared to a horizontal configuration. Nevertheless, some meniscal repair devices have similar biomechanical properties to suture repairs. Both suture repairs and devices have a place in meniscal restoration. LEVEL OF EVIDENCE None, meta-analysis of controlled laboratory studies.
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Erduran M, Hapa O, Şen B, Kocabey Y, Erdemli D, Aksel M, Havitçioğlu H. The effect of inclination angle on the strength of vertical mattress configuration for meniscus repair. Knee Surg Sports Traumatol Arthrosc 2015; 23:41-4. [PMID: 23568388 DOI: 10.1007/s00167-013-2496-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Accepted: 04/03/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE Vertical mattress configuration is the strongest of all other configurations and the repairing devices of meniscus repair. The purpose was whether increasing the inclination angle between two strands of the vertical mattress configuration by increasing the amount of meniscus tissue captured would enhance the initial strength of the construction. METHODS A 2-cm long anteroposterior vertical longitudinal incision was created in two groups of bovine medial menisci. In the first group, the distance between the two vertical suture strands and the vertical horizontal sutures on the capsular side of the meniscal lesion was 2 mm (Group 1). In the second group, the distance was 5 mm (Group 2). The following repair specimens underwent cyclic loading prior to loading the failure testing. The endpoints included ultimate failure load (N), stiffness (N/mm) and cyclic displacement (mm) after the 100 cycles and the mode of failure. RESULTS Group 1 (2 mm) (90.7 (±19.9) N) had lower ultimate load than Group 2 (5 mm) (120.8 (±24.5)) (P < 0.05). Stiffness and displacements during the cycling were not different between the groups (n.s.). All specimens failed by suture rupture. CONCLUSION Increased inclination angle with increased distance between the two vertical suture strands on the capsular side of the meniscal lesion resulted in higher failure load compared to control group with lower inclination angle and distance on the capsular side.
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Affiliation(s)
- Mehmet Erduran
- Department of Orthopedics and Traumatology, Dokuz Eylül University, İnciraltı, Izmir, Turkey
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Choi NH, Kim BY, Hwang Bo BH, Victoroff BN. Suture versus FasT-Fix all-inside meniscus repair at time of anterior cruciate ligament reconstruction. Arthroscopy 2014; 30:1280-6. [PMID: 25085047 DOI: 10.1016/j.arthro.2014.05.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 04/22/2014] [Accepted: 05/19/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare meniscal healing and functional outcomes after all-inside meniscal repair between sutures and meniscal fixation devices. METHODS Sixty patients with a tear within the red-red or red-white zones of the posterior horn of the medial or lateral meniscus in conjunction with an anterior cruciate ligament (ACL) tear were included in this study. Meniscal repairs were performed with sutures in 35 patients and the FasT-Fix device (Smith & Nephew Endoscopy, Andover, MA) in 25 patients concomitantly with hamstring ACL reconstruction. Postoperative evaluations included Lysholm knee score, Tegner activity scale, Lachman and pivot-shift tests, and KT-1000 arthrometer (MEDmetric, San Diego, CA) testing. Follow-up magnetic resonance imaging (MRI) scans were obtained postoperatively for all patients to evaluate meniscal healing. RESULTS The mean follow-up period was 47.2 months. In the suture group, 31 patients (86.1%) were asymptomatic and 4 (13.9%) were symptomatic. In the FasT-Fix group, 20 patients (80%) were asymptomatic and 5 (20%) were symptomatic. Postoperative functional evaluation and knee stability showed no statistically significant difference between the 2 groups. Follow-up MRI showed that 26 menisci (74.3%) were healed, 3 menisci (8.6%) were partially healed, and 6 menisci (17.1%) were not healed in the suture group. In the FasT-Fix group, 15 menisci (64%) were healed, 7 menisci (24%) were partially healed, and 3 menisci (12%) were not healed. Follow-up MRI showed no statistically significant difference between the 2 groups. In the FasT-Fix group, follow-up MRI showed a newly developed cyst posterior to the medial meniscus in 2 patients. A new tear anterior to the previous tear was found in 1 patient. In the suture group, follow-up MRI showed no cysts or new tears. CONCLUSIONS All-inside meniscal repairs using either sutures or the FasT-Fix device showed satisfactory results in patients with concomitant hamstring ACL reconstruction. There was no statistically significant difference in meniscal healing evaluated by MRI and functional outcomes between the 2 techniques. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Nam-Hong Choi
- Department of Orthopaedic Surgery, Eulji Medical Center, Seoul, South Korea.
| | - Byeong-Yeon Kim
- Department of Orthopaedic Surgery, Eulji Medical Center, Seoul, South Korea
| | - Byung-Hun Hwang Bo
- Department of Orthopaedic Surgery, Eulji Medical Center, Seoul, South Korea
| | - Brian N Victoroff
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, Ohio, U.S.A
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Rosso C, Müller S, Buckland DM, Schwenk T, Zimmermann S, de Wild M, Valderrabano V. All-inside meniscal repair devices compared with their matched inside-out vertical mattress suture repair: introducing 10,000 and 100,000 loading cycles. Am J Sports Med 2014; 42:2226-33. [PMID: 24966304 DOI: 10.1177/0363546514538394] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND All-inside arthroscopic meniscal repairs are favored by most clinicians because of their lower complication rate and decreased morbidity compared with inside-out techniques. Until now, only 1000 cycles have been used for biomechanical testing. HYPOTHESIS All-inside meniscal repairs will show inferior biomechanical response to cyclic loading (up to 100,000 cycles) and load-to-failure testing compared with inside-out suture controls. STUDY DESIGN Controlled laboratory study. METHODS Bucket-handle tears in 72 porcine menisci were repaired using the Omnispan and Fast-Fix 360 (all-inside devices) and Orthocord 2-0 and Ultrabraid 2-0 sutures (matched controls). Initial displacement, displacement after cyclic loading (100, 500, 1000, 2000, 5000, 10,000, and 100,000 cycles) between 5 and 20 N, ultimate load to failure, and mode of failure were recorded, as well as stiffness. RESULTS Initial displacement and displacement after cyclic loading were not different between the groups. The Omnispan repair demonstrated the highest load-to-failure force (mean ± SD, 151.3 ± 21.5 N) and was significantly stronger than all the other constructs (Orthocord 2-0, 105.5 ± 20.4 N; Ultrabraid 2-0, 93.4 ± 22.5 N; Fast-Fix 360, 76.6 ± 14.2 N) (P < .0001 for all). The Orthocord vertical inside-out mattress repair was significantly stronger than the Fast-Fix 360 repair (P = .003). The Omnispan (30.8 ± 3.5 N/mm) showed significantly higher stiffness compared with the Ultrabraid 2-0 (22.9 ± 6.9 N/mm, P < .0001) and Fast-Fix 360 (23.7 ± 3.9 N/mm, P = .001). The predominant mode of failure was suture failure. CONCLUSION All-inside meniscal devices show comparable biomechanical properties compared with inside-out suture repair in cyclic loading, even after 100,000 cycles. CLINICAL RELEVANCE Eight to 10 weeks of rehabilitation might not pose a problem for all repairs in this worst-case scenario.
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Affiliation(s)
- Claudio Rosso
- Orthopaedic Department, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Sebastian Müller
- Department of Traumatology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Daniel M Buckland
- Orthopaedic Department, University Hospital Basel, University of Basel, Basel, Switzerland Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Tanja Schwenk
- Orthopaedic Department, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Simon Zimmermann
- School of Life Sciences, Institute for Medical and Analytical Technologies, University of Applied Sciences Northwestern Switzerland, Muttenz, Switzerland
| | - Michael de Wild
- School of Life Sciences, Institute for Medical and Analytical Technologies, University of Applied Sciences Northwestern Switzerland, Muttenz, Switzerland
| | - Victor Valderrabano
- Orthopaedic Department, University Hospital Basel, University of Basel, Basel, Switzerland
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Extra-articular dorsal closing-wedge osteotomy to treat late-stage Freiberg disease using polyblend sutures: technical tips and clinical results. INTERNATIONAL ORTHOPAEDICS 2014; 38:1401-5. [PMID: 24867357 DOI: 10.1007/s00264-014-2381-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Accepted: 05/11/2014] [Indexed: 02/07/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the clinical outcomes regarding the dorsal wedge osteotomy fixed using a polyblend suture and describe the usefulness of this fixation method for the treatment of Freiberg disease. METHODS The subjects consisted of 13 feet from 13 cases suffering from Freiberg disease that underwent extra-articular dorsal closing-wedge osteotomy using a polyblend suture. The average age was 31.7 (range 13-72) years. The average follow-up period was 17 (range 14-24) months. Regarding image findings, time to bone union and metatarsal shortening was reviewed. The investigation was carried out using the range of motion (ROM), visual analog scale (VAS), and Japanese Society of the Surgery of Foot lesser toe scale (JSSF score) in the MTP joint before surgery and at the latest follow-up. RESULTS Calluses under the metatarsal head were not observed in any cases. The mean metatarsal shortening was 2.33 ± 2.07 mm at follow-up. The bone union required an average of 8.4 ± 0.8 weeks. The average ROM of dorsal flexion improved from 37.2 ± 5.3° before surgery to 73.6 ± 9.9° at latest follow-up (p < 0.0001). The average ROM of plantar flexion improved from 16.0 ± 10.1° before surgery to 19.5 ± 8.6° at latest follow-up (p = 0.35). The average VAS significantly improved from 75.3 ± 8.5 before surgery to 4.9 ± 4.2 at latest follow-up (p < 0.0001). The average JSSF score significantly improved from 67.3 ± 9.4 points before surgery to 98.8 ± 3.0 points at the latest follow-up (p < 0.0001). CONCLUSION Extra-articular dorsal closing-wedge osteotomy using a polyblend suture was carried out to treat Freiberg disease. The bone union was observed in all cases with improved clinical results. Fixation using a polyblend suture was considered to be useful.
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Ramappa AJ, Chen A, Hertz B, Wexler M, Grimaldi Bournissaint L, DeAngelis JP, Nazarian A. A biomechanical evaluation of all-inside 2-stitch meniscal repair devices with matched inside-out suture repair. Am J Sports Med 2014; 42:194-9. [PMID: 24114752 DOI: 10.1177/0363546513505190] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Many all-inside suture-based devices are currently available, including the Meniscal Cinch, FasT-Fix, Ultra FasT-Fix, RapidLoc, MaxFire, and CrossFix System. These different devices have been compared in various configurations, but to our knowledge, the Sequent meniscal repair device, which applies running sutures, has not been compared with the Ultra FasT-Fix, nor has it been compared with its suture, No. 0 Hi-Fi, using an inside-out repair technique. PURPOSE To assess the quality of the meniscal repair, all new devices should be compared with the gold standard: the inside-out repair. To that end, this study aims to compare the biomechanical characteristics of running sutures delivered by the Sequent meniscal repair device with 2 vertical mattress sutures applied using the Ultra FasT-Fix device and with 2 vertical mattress sutures using an inside-out repair technique with No. 0 Hi-Fi suture. STUDY DESIGN Controlled laboratory study. METHODS Paired (medial and lateral), fresh-frozen porcine menisci were randomly assigned to 1 of 3 groups: Sequent (n = 17), Ultra FasT-Fix (n = 19), and No. 0 Hi-Fi inside-out repair (n = 20). Bucket-handle tears were created in all menisci and were subjected to repair according to their grouping. Once repaired, the specimens were subjected to cyclic loading (100, 300, and 500 cycles), followed by loading to failure. RESULTS The Sequent and Ultra FasT-Fix device repairs and the suture repair exhibited low initial displacements. The Sequent meniscal repair device demonstrated the lowest displacement in response to cyclic loading. No. 0 Hi-Fi suture yielded the highest load to failure. CONCLUSION With the development of the next generation of all-inside meniscal repair devices, surgeons may use these findings to select the method best suited for their patients. CLINICAL RELEVANCE The Sequent meniscal repair device displays the least amount of displacement during cyclic loading but has a similar failure load to other devices.
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Affiliation(s)
- Arun J Ramappa
- Ara Nazarian, Center for Advanced Orthopaedic Studies, Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, RN115, Boston, MA 02215.
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Hapa O, Akşahin E, Erduran M, Davul S, Havitçioğlu H, LaPrade RF, Bozdağ E, Sünbüloğlu E. The influence of suture material on the strength of horizontal mattress suture configuration for meniscus repair. Knee 2013; 20:577-80. [PMID: 23340094 DOI: 10.1016/j.knee.2012.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 11/26/2012] [Accepted: 11/28/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE Comparison of the mechanical characteristics of meniscal repair fixation using horizontal sutures and six different sutures under submaximal cyclic and load to failure test conditions may aid physicians in selecting a suture type. METHODS A 2-cm long anteroposterior vertical longitudinal incision was created in six groups of bovine medial menisci. Lesions were repaired using a No. 2 suture either composed of polyester or polyester and ultra high-molecular weight polyethylene (UHMWPE), or UHMWPE and polydioxanone or pure UHMWPE. Endpoints included ultimate failure load (N), pull-out stiffness (N/mm), pull-out displacement (mm), cyclic displacement (mm) after 100cycles, after 500cycles, and mode of failure. RESULTS Polyester suture had lower ultimate load than all groups except the suture composed of polyester and UHMWPE (P<.05). Pure UHMWPE suture had higher ultimate failure load than sutures composed of either polyester or polyester plus UHMWPE (P<.05). Predominant failure mode was suture cutting through the meniscus for the groups except for polyester suture which failed by suture rupture. CONCLUSION Under cyclic loading conditions in bovine meniscus, braided polyester suture fixation provided lower initial fixation strength than fixation with various high strength sutures composed of pure UHMWPE or a combination of absorbable monofilament polydioxanone and UHMWPE, except for combination of polyester and UHMWPE sutures. CLINICAL RELEVANCE Present study does not support the usage of the braided polyester sutures instead of high strength sutures composed either partially or totally of ultra-high molecular weight polyethylene for the horizontal suture configuration of meniscus repair.
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Affiliation(s)
- Onur Hapa
- Department of Orthopedics and Traumatology, Dokuz Eylül University, İzmir, Turkey.
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Lee YHD, Nyland J, Burden R, Caborn DNM. Repair of peripheral vertical meniscus lesions in porcine menisci: in vitro biomechanical testing of 3 different meniscus repair devices. Am J Sports Med 2013; 41:1074-81. [PMID: 23475943 DOI: 10.1177/0363546513479775] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND All-inside meniscus repair eliminates the need for an extra incision and decreases neurovascular injury risk. Biomechanical testing can help delineate the efficacy of all-inside device use. HYPOTHESIS There would be no group differences between 4 peripheral meniscus repair techniques and 3 different devices tested. STUDY DESIGN Controlled laboratory study. METHODS Equivalent-sized menisci with attached tibiae were randomly assigned to 1 of 4 test groups (8 specimens each), as follows: group 1, Fast-Fix using No. 0 braided polyester suture; group 2, inside-out repair using 2-0 braided polyester suture; group 3, Sequent using No. 0 ultra-high molecular weight polyethylene (UHMWPE) suture in a continuous "N" configuration; and group 4, Sequent using No. 0 UHMWPE suture in an interrupted configuration. After placement in a clamp, specimens underwent preconditioning from 5 to 20 N for 10 cycles (0.1 Hz), 500 submaximal loading cycles from 5 to 20 N (0.5 Hz), and load-to-failure testing at 12.5 mm/s. A 30-second pause after 10 preconditioning cycles and after 10, 100, and 500 submaximal loading cycles enabled digital photographs to be taken for gapping measurements. Failure mode was recorded. RESULTS Specimens in group 3 withstood greater failure loads than did those in groups 1 and 4 (P ≤ .027), and group 3 specimens were stiffer than those in groups 2 and 4 (P ≤ .048). Displacement during submaximal loading and load-to-failure testing did not differ between groups. Groups 1, 3, and 4 each gapped less than group 2 during submaximal cyclic loading (P ≤ .05). Groups 1 and 2 failed primarily by suture breakage (P < .0001), while groups 3 and 4 failed primarily by the suture pulling free from an implant (P < .0001). CONCLUSION Sequent using No. 0 UHMWPE suture in a continuous "N" configuration displayed superior load at failure compared with repairs using Fast-Fix with No. 0 braided polyester suture and displayed greater stiffness and less gapping than inside-out repair using 2-0 braided polyester suture. The suture pulling free from an implant was the primary failure mode for Sequent using No. 0 UHMWPE suture regardless of whether a continuous "N" or an interrupted configuration was used. Study groups that used No. 0 UHMWPE sutures (groups 3 and 4) had more specimens fail by the suture pulling free from an implant. Compared with the weaker braided polyester suture in the inside-out and Fast-Fix groups, the No. 0 UHMWPE suture used in the Sequent groups likely influenced study results, as this suture has stronger material properties. However, the continuous "N" configuration likely also improved the performance of the Sequent with No. 0 UHMWPE suture, as failure load was significantly less with an interrupted configuration. CLINICAL RELEVANCE All-inside meniscus repair with continuous suture function may translate into improved patient outcomes.
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Affiliation(s)
- Yee Han Dave Lee
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Louisville, Louisville, KY 40202, USA
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Kocabey Y, Taser O, Nyland J, Ince H, Sahin F, Sunbuloglu E, Baysal G. Horizontal suture placement influences meniscal repair fixation strength. Knee Surg Sports Traumatol Arthrosc 2013; 21:615-9. [PMID: 22484371 DOI: 10.1007/s00167-012-1995-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Accepted: 03/26/2012] [Indexed: 11/29/2022]
Abstract
PURPOSE This in vitro biomechanical study investigated the influence of horizontal suture placement distance from the medial meniscal lesion repair site on fixation characteristics during submaximal cyclic and load to failure test conditions. METHODS Eighteen cadaveric (20-45 years of age) medial menisci with intact joint capsules were harvested within 24-48 h after death and divided into two groups of 9 specimens each for biomechanical testing. A 2.0-cm-long antero-posterior vertical longitudinal lesion was created with a #15 scalpel 2.0-3.0 mm from the outer edge of each meniscus. Menisci were repaired using #2-0 suture material with two horizontal suture loops placed either 1.0 mm (Group 1) or 3.0 mm (Group 2) from the lesion site. Following repair, the lesion was extended completely through the meniscal horns so that no tissue secured the repair, only the two horizontal suture loops representing a "worst-case" testing scenario. Following repair, specimens were placed in a servo hydraulic device using a pair of 1.2-mm-diameter steel wire loops and underwent submaximal cyclic loading between 5 and 50 N (1 Hz) for 500 cycles prior to load to failure testing (5 mm/min crosshead speed, 20 Hz data collection). An alpha level of P < 0.05 was selected to indicate statistical significance. RESULTS Five of nine (55.6 %) Group 1 specimens did not complete submaximal cyclic testing. All Group 2 specimens completed submaximal cyclic testing (Fisher's exact test P = 0.029). Statistically significant mean group differences were not observed for displacement during submaximal cyclic loading (Group 1 = 5.0 ± 1.5 mm and Group 2 = 5.7 ± 1.6 mm) or for construct stiffness during load to failure testing (Group 1 = 50.1 ± 6.3 N/mm and Group 2 = 52.6 ± 11.9 N/mm). Group 2 displayed greater mean load at failure (112.1 ± 40.8 N vs. 72.7 ± 11.2 N, P = 0.02) and mean displacement at failure (11.1 ± 2.2 mm vs. 7.6 ± 1.4 mm, P = 0.03) than Group 1. CONCLUSIONS Horizontal sutures placed slightly farther away from the meniscus lesion displayed superior repair fixation than sutures placed closer to the lesion. The superior biomechanical meniscal repair fixation provided by capturing greater tissue volume may enable safe earlier participation in functional exercise activities. Studies are needed to verify these findings in vivo.
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Affiliation(s)
- Yavuz Kocabey
- Department of Orthopaedics and Traumatology, Kocaeli Acibadem Hospital, Kocaeli, Turkey
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Lee YHD, Nyland J, Burden R, Caborn DNM. Cyclic test comparison of all-inside device and inside-out sutures for radial meniscus lesion repair: an in vitro porcine model study. Arthroscopy 2012; 28:1873-81. [PMID: 23085200 DOI: 10.1016/j.arthro.2012.06.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 05/10/2012] [Accepted: 06/13/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare biomechanical fixation and gapping characteristics of a new all-inside meniscus repair method for radial meniscus lesion repair versus conventional inside-out suture repair under submaximal cyclic loading and load-to-failure test conditions. METHODS Fresh-frozen porcine tibiae with attached lateral menisci and joint capsules were harvested and stored for 48 hours at -20°C. After thawing for 12 hours, equivalent-size healthy specimens were randomly assigned to 2 groups of 8 specimens each. Standardized radial lesions were repaired with the Sequent device (ConMed Linvatec, Largo, FL) (group 1) or conventional inside-out suturing with No. 2-0 braided polyester suture (group 2). Repaired specimens were placed in custom clamps and mounted on a servohydraulic device. After a 2-N preload, specimens were cycled from 5 to 20 N (0.1 Hz), before undergoing 1,000 submaximal loading cycles between 5 and 20 N (0.5 Hz). A 40-second delay at 100, 500, and 1,000 cycles enabled digital photographs to be taken for gapping measurement determination. Specimens then underwent load-to-failure testing (12.5 mm/s). Fixation failure mode was documented. RESULTS Group displacement did not differ after 1, 100, 500, and 1,000 submaximal loading cycles. Group peak gapping did not differ at 100, 500, and 1,000 submaximal loading cycles. Load at failure and displacement and stiffness during load-to-failure testing did not differ between groups. During load-to-failure testing, all-inside specimens failed by implant dislodgement from the meniscus periphery whereas the inside-out repaired specimens failed by suture rupture. CONCLUSIONS Under controlled in vitro biomechanical test conditions, the all-inside device provided radial meniscus lesion fixation that was comparable, but not superior, to conventional inside-out suturing. CLINICAL RELEVANCE The all-inside radial lateral meniscus lesion repair method may provide comparable fixation to conventional inside-out suturing without the need for additional incisions and their associated neurovascular injury risks.
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Affiliation(s)
- Yee Han Dave Lee
- Division of Sports Medicine, Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky 40202, USA
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Tuman J, Haro MS, Foley S, Diduch D. All-inside meniscal repair devices and techniques. Expert Rev Med Devices 2012; 9:147-57. [PMID: 22404776 DOI: 10.1586/erd.11.74] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Techniques and devices for meniscal repair are evolving, including for all-inside meniscal repair. The first-generation all-inside meniscal repair devices were simplistic in design, but their technical difficulties and risks led to the development of second-generation devices. These devices employed the suture anchor concept for repair and confirmed the safety of use through standard anterior arthroscopic portals. Third-generation devices introduced the idea of rigid, bioabsorbable materials; unfortunately, these demonstrated higher failure and complication rates compared with other repair techniques. They were also limited in their ability to adjust compression and tension across the repair. Now, fourth-generation devices have been developed that are flexible, suture-based, and allow for variable compression and retensioning across the tear. Each device has its own specifications and technical nuances. With a comprehensive understanding of the current devices available, the industry and surgeons may continue in the development of safer, more successful, user-friendly and cost-effective all-inside devices.
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Affiliation(s)
- Jeff Tuman
- UVA Department of Orthopedic Surgery, 500 Ray C Hunt Drive, Box 800159, Charlottesville, VA 22908, USA
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Barber FA, Herbert MA, Bava ED, Drew OR. Biomechanical testing of suture-based meniscal repair devices containing ultrahigh-molecular-weight polyethylene suture: update 2011. Arthroscopy 2012; 28:827-34. [PMID: 22317797 DOI: 10.1016/j.arthro.2011.11.020] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Revised: 11/16/2011] [Accepted: 11/17/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the biomechanical characteristics of recently introduced ultrahigh-molecular-weight polyethylene suture-based, self-adjusting meniscal repair devices. METHODS Updating a prior study published in 2009, we made vertical longitudinal cuts 3 mm from the periphery in fresh-frozen adult human menisci to simulate a bucket-handle meniscus tear. Each tear was then repaired by a single repair technique in 10 meniscus specimens. Group 1 menisci were repaired with a vertical mattress suture of No. 2-0 Ethibond (Ethicon, Somerville, NJ). Group 2 menisci were repaired with a vertical mattress suture of No. 2-0 OrthoCord (DePuy Mitek, Raynham, MA). Group 3 menisci were repaired with a single OmniSpan device with No. 2-0 OrthoCord suture (DePuy Mitek). Group 4 menisci were repaired with a single Meniscal Cinch device with No. 2-0 FiberWire suture (Arthrex, Naples, FL). Group 5 menisci were repaired with a single MaxFire device inserted with the MarXmen gun (Biomet Sports Medicine, Warsaw, IN). Group 6 menisci were repaired with a Sequent device with No. 0 Hi-Fi suture (ConMed Linvatec, Largo, FL) in a "V" suture configuration. Group 7 menisci were repaired with a single FasT-Fix 360 device (Smith & Nephew Endoscopy, Andover, MA). By use of a mechanical testing machine, all samples were preloaded at 5 N and cycled 200 times between 5 and 50 N. Those specimens that survived were destructively tested at 5 mm/min. Endpoints included maximum load, displacement, stiffness, and failure mode. RESULTS Mean failure loads were as follows: Ethibond suture, 73 N; OrthoCord suture, 88 N; OmniSpan, 88 N; Cinch, 71 N; MarXmen/MaxFire, 54 N; Sequent, 66 N; and FasT-Fix 360, 60 N. Ethibond was stronger than MarXmen/MaxFire. The mean displacement after 100 cycles was as follows: Ethibond, 2.58 mm; OrthoCord, 2.75 mm; OmniSpan, 2.51 mm; Cinch, 2.65 mm; MarXmen/MaxFire, 3.67 mm; Sequent, 3.35 mm; and FasT-Fix 360, 1.13 mm. The MarXmen/MaxFire showed greater 100-cycle displacement than Ethibond and FasT-Fix 360. No difference in stiffness existed for these devices, and failure mode varied without specific trends. CONCLUSIONS The biomechanical properties of meniscal repairs using the OmniSpan, Cinch, Sequent, and FasT-Fix 360 devices are equivalent to suture repair techniques. However, the MarXmen/MaxFire meniscal repair device showed significantly lower failure loads and survived less cyclic loading in the human cadaveric meniscus than other tested repairs. CLINICAL RELEVANCE Most commercially available devices for all-inside meniscal repair using ultrahigh-molecular-weight polyethylene suture provide fixation comparable to the classic vertical mattress suture repair technique in human cadaveric meniscus.
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Affiliation(s)
- F Alan Barber
- Plano Orthopedic Sports Medicine and Spine Center, Plano, Texas, U.S.A
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Rosso C, Kovtun K, Dow W, McKenzie B, Nazarian A, DeAngelis JP, Ramappa AJ. Comparison of all-inside meniscal repair devices with matched inside-out suture repair. Am J Sports Med 2011; 39:2634-9. [PMID: 21997730 DOI: 10.1177/0363546511424723] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND All-inside meniscal repairs are performed with increasing frequency because of the availability of newly developed devices. A comparison of their biomechanical characteristics may aid physicians in selecting a method of meniscal repair. HYPOTHESIS All-inside meniscal repairs will be superior to their inside-out controls in response to cyclic loading and load-to-failure testing. STUDY DESIGN Controlled laboratory study. METHODS Sixty-six bucket-handle tears in matched porcine menisci were repaired using the Ultra FasT-Fix, Meniscal Cinch, Ultrabraid No. 0, and FiberWire 2-0 sutures. Initial displacement, cyclic loading (100, 300, and 500 cycles), and load-to-failure testing were performed. The displacement, response to cyclic loading, and mode of failure were recorded. The stiffness was calculated. RESULTS The Meniscal Cinch demonstrated a significantly higher initial displacement than the other methods tested (P = .04). No significant difference was found among the methods in response to cyclic loading. The inside-out FiberWire repair demonstrated the highest load to failure (120.8 ± 23.5 N) and was significantly higher than both the Meniscal Cinch (64.8 ± 24.1 N, P < .001) and the Ultra FasT-Fix (88.3 ± 14.3 N, P = .002). It was not significantly higher than the inside-out Ultrabraid suture repair (98.8 ± 29.2 N). The inside-out FiberWire repair had the highest stiffness (28.7 ± 7.8 N/mm). It was significantly higher than the Meniscal Cinch (18.0 ± 8.8 N/mm, P = .01). The most common mode of failure in all methods was suture failure. CONCLUSION An inside-out suture repair affords surgeons the best overall biomechanical characteristics of the devices tested (initial displacement, response to cyclic loading, and load to failure). For an all-inside repair, the Ultra FasT-Fix reproduces the characteristics of its matched inside-out suture repair more closely than the Meniscal Cinch. CLINICAL RELEVANCE Inside-out sutures and all-inside devices have similar responses to cyclic loading.
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Affiliation(s)
- Claudio Rosso
- Center for Advanced Orthopaedic Studies, Harvard Medical School, Boston, Massachusetts, USA
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Melton JTK, Murray JR, Karim A, Pandit H, Wandless F, Thomas NP. Meniscal repair in anterior cruciate ligament reconstruction: a long-term outcome study. Knee Surg Sports Traumatol Arthrosc 2011; 19:1729-34. [PMID: 21479642 DOI: 10.1007/s00167-011-1501-5] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Accepted: 03/21/2011] [Indexed: 02/08/2023]
Abstract
PURPOSE To study the long-term outcome of patients who have undergone inside-out, vertical stacked mattress suture repair of meniscal tears combined with anterior cruciate ligament (ACL) reconstruction. METHODS From a database of ACL reconstructed patients, consecutive patients undergoing concomitant meniscal repair and ACL reconstruction between 1991 and 1999 were identified. Patients with previous ACL or meniscal pathology were excluded. Two age- and sex-matched cohorts who had undergone combined ACL reconstruction and menisectomy and who had undergone ACL reconstruction with normal menisci were identified for comparison. Outcome scoring included IKDC and Lysholm scores for the meniscal repair group. Two sample t-tests and chi-square tests were used to compare the IKDC subjective scores, with a minimum level of significance set at 5% (P = 0.05). RESULTS Fourty-four patients were identified for analysis with a median follow-up of 10 years (7.7-12.6). Patients undergoing ACL reconstruction combined with meniscal repair had a mean IKDC of 84.2 compared with a mean score of 70.5 (P = 0.008) in patients who had undergone menisectomy and 88.2 (P = 0.005) in patients with intact menisci. 86.2% of patients with ACL reconstruction and meniscal repair had Lysholm score of between 80 and 100%. Sixty-nine percent follow-up was achieved. Survival analysis by life table method shows a best case of 89% 10-years survival. CONCLUSIONS This study demonstrates that good long-term outcomes can be obtained in patients up to over 12 years after combined ACL reconstruction and meniscal repair. Improved functional scores can be achieved when compared with ACL reconstruction and menisectomy. The authors advocate repair of meniscal tears during ACL reconstruction unless there is complex tearing, radial tearing or plastic deformation of the remaining meniscus. LEVEL OF EVIDENCE III.
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Affiliation(s)
- J T K Melton
- Trauma and Orthopaedics, North Hampshire Hospital, Aldermaston Road, Basingstoke, RG24 9NA, UK.
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Aros BC, Pedroza A, Vasileff WK, Litsky AS, Flanigan DC. Mechanical comparison of meniscal repair devices with mattress suture devices in vitro. Knee Surg Sports Traumatol Arthrosc 2010; 18:1594-8. [PMID: 20532866 DOI: 10.1007/s00167-010-1188-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Accepted: 05/25/2010] [Indexed: 01/14/2023]
Abstract
We report the load to failure in tensile testing of the MaxFire™ meniscal repair system (Biomet Inc, Warsaw, IN) and compare it to other current meniscal repair devices and mattress suture techniques. After creating a longitudinal tear in 42 one-year-old bovine menisci, 7 specimen groups defined by the meniscal repair device, suture, and/or mattress technique used for meniscal repair were randomly established: (Group 1: Fiberwire™ vertical mattress (VM), Group 2: Fiberwire™ horizontal mattress (HM), Group 3: FasT-Fix™ VM, Group 4: FasT-Fix™ HM, Group 5: RapidLoc™, Group 6: MaxFire™ VM, Group 7: MaxFire™ HM). After completing the repairs, the meniscal specimens were cyclically pre-loaded before load to failure testing was performed. The mean load to failure for each group was: Fiberwire VM (185 ± 41 N), Fiberwire HM (183 ± 36 N), FasT-Fix VM (125 ± 8 N), FasT-Fix HM (107 ± 29 N), RapidLoc (70 ± 12 N), MaxFire VM (145 ± 44 N), MaxFire HM (139 ± 50 N). An analysis of variance demonstrated a significant difference in the mean load to failure (F = 8.31 P < 0.01). Statistically significant differences were seen between both Fiberwire groups verses FasT-Fix HM and Rapid-Loc (P < 0.05). Three modes of failure were observed: suture breakage (17/42, 40.5%), tissue failure (18/42, 42.9%), and knot failure (7/42, 16.7%). 2-0 Fiberwire™ VM and HM repairs had the highest load to failure of all groups tested. The load to failure for the MaxFire™ meniscal repair system is comparable to other available all-inside meniscal repair systems.
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Affiliation(s)
- Brian C Aros
- Green Mountain Orthopaedic Surgery, Berlin, VT, USA
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Blacquier B. Meniscal repair device. Arthroscopy 2010; 26:575; author reply 575. [PMID: 20434649 DOI: 10.1016/j.arthro.2010.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Accepted: 03/22/2010] [Indexed: 02/02/2023]
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