Arthroscopic Transtibial Pull-Out Repair for Meniscal Posterior Root Tear: The Slip Knot Technique

Biomechanical analysis of four different meniscus suturing techniques for posterior meniscal root pull-out repair: A human cadaveric study

Purpose

To compare the biomechanical properties of the slip-knot technique with three other transtibial pullout suture repair constructs for meniscal root tears.

Method

Thirty-two fresh-frozen cadaveric menisci were randomly allocated to four meniscus-suture fixation constructs: Two simple-sutures (TSS), two slip-knot (TSK) sutures, two cinch-loop (TCL) sutures, and two modified Mason-Allen (TMMA) sutures. Cyclic loading from 5 to 20 N was conducted for 1000 cycles at 0.5 Hz, and then loaded to failure at 0.5 mm/s. Parametric data (displacement during cyclic loading, ultimate load, yield load, and displacement at failure) were analysed using a one-way analysis of variance (ANOVA), whereas nonparametric data (stiffness) were analysed using the Kruskal-Wallis test.

Results

After 1000 cycles, the TCL construct significantly displaced the most (mean ± SD, 6.78 ± 1.32 mm; p < 0.001), followed by the TMMA (2.83 ± 0.90 mm), TSK (2.33 ± 0.57 mm), and TSS (2.03 ± 0.62 mm) groups. On ultimate failure load, there was no significant difference between the TSK group (123.48 ± 27.24 N, p > 0.05) and the other three groups (TSS, 94.65 ± 25.33 N; TMMA, 168.38 ± 23.24 N; TCL, 170.54 ± 57.32 N); however, it exhibited the least displacement (5.53 ± 1.25 mm) which was significantly shorter than those of the TCL (11.82 ± 4.25 mm, p < 0.001) and TMMA (9.53 ± 2.18 mm, p = 0.03) constructs. No significant difference in stiffness was observed among the four meniscus-suture constructs.

Conclusion

The slip-knot technique has proven to be a simple, yet robust and stable meniscal root fixation option; moreover, it exhibited superiority over the more complex modified Mason-Allen suture construct in resisting displacement at the ultimate failure load.

Level of Evidence

Not applicable.

Short-term results of tibial interference screw fixation for transtibial medial meniscus posterior root pull-out repair

Background

To evaluate the technique of transtibial pull-out repair with tibial interference screw fixation for medial meniscus posterior root (MMPR) tear by reporting on short-term outcomes and complications.

Methods

All MMPR repairs performed between January 2019 and August 2021 (n = 70) were retrospectively screened regarding demographic data and surgical parameters. The patients were questioned for performed revision surgery, symptoms and complications. The Numeric Rating Scale (NRS) for pain, Lysholm Knee Score and International Knee Documentation Committee Subjective Knee Form (IKDC) questionnaires were used to evaluate clinical outcome. In cases of revision surgery for re-tear the mode of failure was intraoperatively classified (patients with re-tear were excluded from the clinical follow-up examination). The influence of demographic and treatment parameters (surgical and rehabilitation) on the incidence and mode of re-tear and clinical scores was evaluated.

Results

After 2.3 ± 0.7 years, 62 patients (88.6 %) were available for follow-up. There were no direct intra- or postoperative complications. No revision was performed due to symptoms related to the tibial fixation material. The mean surgery time was 33.5 ± 10.8 min. The overall re-tear rate was 17.7 % (11 patients) of whom 10 were treated surgically and one conservatively. Primary mode of failure was suture cut-out from the meniscus (70 %). The NRS, Lysholm Knee Score and subjective IKDC were obtained in 38 patients and improved from 6.8 ± 2.4, 40.1 ± 23.9 and 32.8 ± 16.3 to 2.2 ± 2.2, 80.5 ± 16.3 and 63.0 ± 13.9, respectively (all p < 0.001). No influence was observed from demographic and treatment parameters on re-tear rates or clinical Scores.

Conclusions

Tibial interference screw fixation is a fast and promising technique for MMPR transtibial pull-out repair. In the presented technique, utilizing non-absorbable locking sutures alongside tibial interfenrence screw fixation, the primary mode of failure was suture cut-out from the meniscus.

Application of Continuous Sewing Machine-Like Suture Technique in Meniscus Injury

Meniscus injury is a common type of knee joint injury and often requires arthroscopic repair. At present, meniscus repair methods mainly include inside-out technology, outside-in technology, and all-inside technology. Among them, all-inside technology has attracted more attention from clinicians because of its better results. To improve the shortcomings of all-inside technology, we describe a "continuous sewing machine-like" suture technique. Our technique can make the meniscus suture continuous, increase its flexibility, and also enhance the stability of the suture knot through multiple puncture suture. Our technology can be applied to more-complex meniscus injuries and can greatly reduce the cost of surgery.