Biomechanical comparison of four tibial fixation techniques for meniscal root sutures in posterior medial meniscus root repair: A porcine study

Abstract

Objective This study hypothesized that the suture anchor of tibial fixation method of PMMR repair technique is the main factor which reduce the gap formation or over displacement of tear site in initial healing, and then investigated the fixation stability of 4 different tibial fixations through cyclic and ultimate failure load testing of meniscal root sutures. Methods Twenty-four porcine tibiae with intact medial meniscus roots were randomly assigned into 4 groups: transosseous suture, washer, suture anchor, or screw with washer. Each sample underwent cyclic loading followed by a load-to-failure test. Displacement, maximum load to failure, stiffness, and elongation at failure load were recorded. Results The maximum average load and displacement at failure for each of the repair groups were as follows: transosseous suture, 232.8 N and 12.16 mm; washer, 189.9 N and 21.5 mm; suture anchor, 140.6 N and 13.8 mm; and screw with washer, 167.9 N and 18.9 mm. The maximum stiffness values for each of the repair groups were as follows: transosseous suture, 19.5 ± 0.7 N/mm; washer, 21.5 ± 1.4 N/mm; suture anchor, 13.8 ± 0.7 N/mm; and screw with washer, 18.9 ± 3.9 N/mm. The mean elongation across the repairs for each of the repair groups after 1000 loading cycles was: transosseous suture, 3.74 ± 0.28 mm; washer, 3.04 ± 0.13 mm; suture anchor, 2.25 ± 0.33 mm; and screw with washer, 2.43 ± 0.19 mm. The mean elongation was significantly less with the suture anchor than with the other techniques ( p < .05). Conclusion Under physiological loading, our results indicate that a slower rehabilitation program with limited flexion and only partial weight bearing is advised when using a suture anchor because of the lower maximum load and stiffness. The translational potential of this article Tibial fixation using a washer or a screw with a washer is an effective and cost-saving technique when an option is required with high stiffness and low displacement at failure.

Arthroscopic Medial Meniscus Posterior Root Reconstruction and Pull-Out Repair Combined Technique for Root Tear of Medial Meniscus

“…Furthermore, we simultaneously use the pull-out repair technique. A study using pig knees found that the failure load of the pull-out repair using a washer was 189.9 N. 22 Thus, our method can apply stronger traction.…”

Medial Meniscus Root Tear: Current Update Review

“…In contrast, a study by Wu et al showed that anchor suture had lower maximum load and stiffness compared with transtibial technique but the mean elongation was less. The reason might be because of the different techniques and the study was done with porcine knees which are different from human [64].…”

Radial and longitudinal meniscus tears show different gapping patterns under stance phase conditions

“…The first approaches to quantify meniscal tear gapping were simplified uniaxial ex vivo tensile tests using standard testing machines. [20][21][22][23][24][25][26][27][28] Other groups have utilized magnetic resonance imaging (MRI) [29][30][31][32] to assess meniscal gapping in vivo under static knee flexion angles. Dürselen et al were one of the first to identify gapping under moderate dynamic loading conditions by means of a knee simulator 33,34 and found a significant gapping behaviour of longitudinal tears.…”

“…By contrast, McCulloch and Lin et al in their studies rather observed a compression of longitudinal tears under gait-like conditions, 35,36 leading to significant debate. From a technological point of view, meniscus gapping was assessed optically by movement deflection, [20][21][22][23][24][25][26][27][28] MRI, [29][30][31][32] arthroscopically 33,34 and Roentgen stereophotogrammetric analysis (RSA). 35,36 To the best of the authors' knowledge, meniscal tear gapping has only been studied independently of the related tibiofemoral contact pressure, which is an important contributor to a healthy knee joint.…”