Cyclic Displacement After Meniscal Root Repair Fixation: A Human Biomechanical Evaluation

• Published in: The American journal of sports medicine 2015-04, Vol.43 (4), p.892-898
• Main Authors: LaPrade, Robert F., LaPrade, Christopher M., Ellman, Michael B., Turnbull, Travis Lee, Cerminara, Anthony J., Wijdicks, Coen A.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Biomechanical Phenomena; Biomechanics; Cartilage Diseases - surgery; Child; Female; Humans; Hypotheses; In Vitro Techniques; Knee; Knee Injuries - surgery; Male; Menisci, Tibial - surgery; Optimization techniques; Skin & tissue grafts; Sports medicine; Surgery; Suture Techniques; Sutures; Transplants & implants; Young Adult
• ISSN: 0363-5465; 1552-3365
• DOI: 10.1177/0363546514562554

Background: Recent biomechanical evidence suggests that the meniscus-suture interface contributes the most displacement to the transtibial pull-out repair for meniscal root tears. Therefore, optimization of surgical technique at the meniscus-suture interface may minimize displacement and improve the strength of meniscal root repairs. Purpose/Hypothesis: The purpose of this study was to investigate the cyclic displacement and ultimate failure loads of 4 different meniscus-suture fixation techniques for posterior medial meniscal root repairs in human meniscus tissue. The hypothesis was that there would be no significant difference between the two simple sutures (TSS) technique and 3 other techniques in cyclic displacement or ultimate failure load. Study Design: Controlled laboratory study. Methods: A total of 32 fresh-frozen, human, medial meniscal transplant specimens were randomly assigned to 4 meniscus-suture fixation techniques used for transtibial pull-out repair in posterior medial meniscal root tears (n = 8 per group). The suture techniques studied were (1) TSS, (2) modified Mason-Allen (MMA), (3) single double-locking loop (S-DLL), and (4) double double-locking loop (D-DLL). The menisci were subjected to a cyclic tensioning protocol representative of postoperative rehabilitation (10-30 N for 1000 cycles) and pulled to failure at a rate of 0.5 mm/s. Results: After 1000 cycles, the TSS group displaced the least (mean ± SD, 1.78 ± 0.64 mm), followed by the MMA (2.14 ± 0.65 mm), D-DLL (2.97 ± 0.57 mm), and S-DLL (3.81 ± 0.78 mm) groups. After 100, 500, and 1000 cycles, suture displacements using the TSS and MMA techniques were not significantly different (P > .13), while the TSS technique resulted in significantly less displacement than the S-DLL and D-DLL (P < .03) techniques. The ultimate failure loads of the MMA (325 ± 77 N) and D-DLL (320 ± 50 N) techniques were significantly greater than those of the TSS (192 ± 52 N) and S-DLL (217 ± 51 N) techniques (P < .05). Conclusion: The TSS and MMA fixation techniques were not significantly different, while the TSS was significantly better at resisting displacement when compared with the S-DLL and D-DLL stitch configurations. The MMA and D-DLL techniques exhibited significantly greater failure loads than did the TSS and S-DLL techniques; however, all techniques demonstrated ultimate failure loads above the currently accepted rehabilitation force threshold. Clinical Relevance: The TSS fixation technique combin