Abstract
Purpose
To assess the role of suture cutout in the mechanics of failure of the repaired posterior meniscal root during the early post-operative period when using sutures of different shape.
Methods
Twenty medial porcine menisci were randomized in two groups depending on the suture shape used to repair the posterior root: thread or tape. The sutured menisci were subjected to cyclic loading (1000 cycles, (10, 30) N) followed by load-to-failure testing. Residual displacements, stiffness, and ultimate failure load were determined. During tests, the tissue-suture interface was recorded using a high-resolution camera.
Results
In cyclic tests, cutout progression at the suture insertion points was not observed for any specimen of either group and no differences in residual displacements were found between use of thread or tape. In load-to-failure tests, suture cutout started in all menisci at a load close to the ultimate failure and all specimens failed by suture pullout. Suture tape had a greater ultimate load with no other differences.
Conclusions
In a porcine model of a repaired posterior meniscal root subjected to cyclic loads representative of current rehabilitation protocols in the early post-operative period under restricted loading conditions, suture cutout was not found as a main source of permanent root displacement when using suture thread or tape. Suture cutout progression started at high loading levels close to the ultimate load of the construct. Tape, with a meniscus-suture contact area larger than thread, produced higher ultimate load.
Similar content being viewed by others
References
Allaire R, Muriuki M, Gilbertson L, Harner CD (2008) Biomechanical consequences of a tear of the posterior root of the medial meniscus. Similar to total meniscectomy. J Bone Jt Surg Am 90(9):1922–1931. https://doi.org/10.2106/JBJS.G.00748
Seo JH, Li G, Shetty GM et al (2009) Effect of repair of radial tears at the root of the posterior horn of the medial meniscus with the pullout suture technique: a biomechanical study using porcine knees. Arthroscopy 25(11):1281–1287. https://doi.org/10.1016/j.arthro.2009.05.014
Padalecki JR, Jansson KS, Smith SD et al (2014) Biomechanical consequences of a complete radial tear adjacent to the medial meniscus posterior root attachment site: in situ pull-out repair restores derangement of joint mechanics. Am J Sports Med 42(3):699–707. https://doi.org/10.1177/0363546513499314
Forkel P, Herbort M, Sprenker F et al (2014) The biomechanical effect of a lateral meniscus posterior root tear with and without damage to the meniscofemoral ligament: efficacy of different repair techniques. Arthroscopy 30(7):833–840. https://doi.org/10.1016/j.arthro.2014.02.040
LaPrade CM, Jansson KS, Dornan G et al (2014) Altered tibiofemoral contact mechanics due to lateral meniscus posterior horn root avulsions and radial tears can be restored with in situ pull-out suture repairs. J Bone Joint Surg Am 96(6):471–479. https://doi.org/10.2106/JBJS.L.01252
Perez-Blanca A, Espejo-Baena A, Amat TD et al (2016) Comparative biomechanical study on contact alterations after lateral meniscus posterior root avulsion, transosseous reinsertion, and total meniscectomy. Arthroscopy 32(4):624–633. https://doi.org/10.1016/j.arthro.2015.08.040
Shybut TB, Vega CE, Haddad J et al (2015) Effect of lateral meniscal root tear on the stability of the anterior cruciate ligament-deficient knee. Am J Sports Med 43(4):905–911. https://doi.org/10.1177/0363546514563910
Ropke EF, Kopf S, Drange S et al (2015) Biomechanical evaluation of meniscal root repair: a porcine study. Knee Surg Sports Traumatol Arthrosc 23(1):45–50. https://doi.org/10.1007/s00167-013-2589-6
Kim JH, Chung JH, Lee DH et al (2011) Arthroscopic suture anchor repair versus pullout suture repair in posterior root tear of the medial meniscus: a prospective comparison study. Arthroscopy 27(12):1644–1653. https://doi.org/10.1016/j.arthro.2011.06.033
Feucht MJ, Kühle J, Bode G et al (2015) Arthroscopic transtibial pullout repair for posterior medial meniscus root tears: a systematic review of clinical, radiographic, and second-look arthroscopic results. Arthorscopy 31(19):1808–1816. https://doi.org/10.1016/j.arthro.2015.03.022
Cerminara AJ, LaPrade CM, Smith SD et al (2014) Biomechanical valuation of a transtibial pull-out meniscal root repair: challenging the bungee effect. Am J Sports Med 42(12):2988–2995. https://doi.org/10.1177/0363546514549447
Feucht MJ, Grande E, Brunhuber J, Rosenstiel N, Burgkart R, Imhoff AB, Braun S (2014) Biomechanical comparison between suture anchor and transtibial pull-out repair for posterior medial meniscus root tears. Am J Sports Med 42(1):187–193. https://doi.org/10.1177/0363546513502946
Starke C, Kopf S, Grobel K, Becker R (2010) The effect of a nonanatomical repair of the meniscal horn attachment on meniscal tension: a biomechanical study. Arthroscopy 26(3):358–365. https://doi.org/10.1016/j.arthro.2009.08.013
LaPrade CM, Foad A, Smith SD et al (2015) Biomechanical consequences of a nonanatomic posterior medial meniscal root repair. Am J Sports Med 43(4):912–920. https://doi.org/10.1177/0363546514566191
Espejo-Baena A, Figueroa-Mata A, Serrano-Fernández J, de la Torre-Solís F (2008) All-inside suture technique using anterior portals in posterior horn tears of lateral meniscus. Arthroscopy 24(3):369.e1–369.e4. https://doi.org/10.1016/j.arthro.2007.06.017
Lee DW, Jang SH, Ha JK et al (2013) Meniscus root refixation technique using a modified Mason-Allen stitch. Knee Surg Sports Traumatol Arthrosc 21(3):654–657. https://doi.org/10.1007/s00167-012-1992-8
LaPrade RF, LaPrade CM, James EW (2015) Recent advances in posterior meniscal root repair techniques. J Am Acad Orthop Surg 23(2):71–76. https://doi.org/10.5435/JAAOS-D-14-00003
Kopf S, Colvin AC, Muriuki M et al (2011) Meniscal root suturing techniques: implications for root fixation. Am J Sports Med 39(10):2141–2146. https://doi.org/10.1177/0363546511413250
Feucht MJ, Grande E, Brunhuber J et al (2013) Biomechanical evaluation of different suture techniques for arthroscopic transtibial pull-out repair of posterior medial meniscus root tears. Am J Sports Med 41(12):2784–2790. https://doi.org/10.1177/0363546513502464
LaPrade RF, LaPrade CM, Ellman MB et al (2015) Cyclic displacement after meniscal root repair fixation: a human biomechanical evaluation. Am J Sports Med 43(4):892–898. https://doi.org/10.1177/0363546514562554
Fujii M, Furumatsu T, Xue H et al (2017) Tensile strength of the pullout repair technique for the medial meniscus posterior root tear: a porcine study. Int Orthop 41(10):2113–2118. https://doi.org/10.1007/s00264-017-3561-8
Feucht MJ, Grande E, Brunhuber J et al (2015) Biomechanical evaluation of different suture materials for arthroscopic transtibial pull-out repair of posterior meniscus root tears. Knee Surg Sports Traumatol Arthrosc 23(1):132–139. https://doi.org/10.1007/s00167-013-2656-z
Espejo-Baena A, Urbano-Labajos V, Ruiz del Pino MJ, Peral-Infantes I (2004) A simple device for inside-out meniscal suture. Arthroscopy 20(8):e85–e87. https://doi.org/10.1016/j.arthro.2004.07.006
Starke C, Kopf S, Lippisch R et al (2013) Tensile forces on repaired medial meniscal root tears. Arthroscopy 29(2):205–212. https://doi.org/10.1016/j.arthro.2012.09.004
Faul F, Erdfelde E, Lang A-G, Buchner A (2007) G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 39(2):175–191
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
This article does not contain any studies with human participants or animals performed by any of the authors.
Rights and permissions
About this article
Cite this article
Perez-Blanca, A., Prado Nóvoa, M., Lombardo Torre, M. et al. The role of suture cutout in the failure of meniscal root repair during the early post-operative period: a biomechanical study. International Orthopaedics (SICOT) 42, 811–818 (2018). https://doi.org/10.1007/s00264-018-3799-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00264-018-3799-9