Biomechanical Comparison of Parallel and Crossed Suture Repair for Longitudinal Meniscus Tears

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.

The rebar repair for radial meniscus tears: a biomechanical comparison of a reinforced suture repair versus parallel and cross-stitch techniques

“…The load to failure values for the parallel and cross-stitch reported by Matsubara were, however similar to the current study. In previous studies, pneumatic grips were used on both roots which may have led to slippage (Branch et al 2015; Matsubara et al 2012; Milchteim et al 2016).…”

“…The trend toward radial tears has been shifting towards repair (Abrams et al 2013). Newer techniques have demonstrated some success with repair of the radial meniscus tear with promising results seen both biomechanically and clinically (Beamer et al 2015; Bhatia et al 2016; Branch et al 2015; Buckley et al 2019; Choi et al 2010; Haklar et al 2008; Lee et al 2012; Matsubara et al 2012; Milchteim et al 2016; Nakata et al 2011; Noyes and Barber-Westin 2012; Stender et al 2018; Bedi et al 2010). The standard technique used has classically been the parallel stitch, but recently a cross stich method has been suggested to outperform the cross stitch (Matsubara et al 2012).…”

Biomechanical Comparison of Vertical Mattress and Cross-stitch Suture Techniques and Single- and Double-Row Configurations for the Treatment of Bucket-Handle Medial Meniscal Tears

“…16,35 Regarding comparisons between the cross-stitch and vertical mattress sutures, 2 other studies biomechanically evaluated single-row configurations and found no differences, similar to our single-row results. 33,40 Milchteim et al 33 compared 2 parallel vertical mattress sutures to 2 crossed sutures for a 1-cm complete longitudinal tear on a cadaveric human meniscus and observed no significant differences in failure load and stiffness. In a canine model, Thiemen et al 40 compared contact pressures following repair of a bucket-handle tear with a horizontal, vertical, or crossstitch repair technique and found no differences among repair groups with a 150-N limit crescent load at a single knee flexion angle.…”

“…34 The vertical mattress suture pattern for meniscal repairs is performed because of its reported biomechanical superiority over horizontal mattress sutures. 13,20,23,25,39,40,42 However, it remains unknown whether restoration of native joint kinematics and contact pressures may be more optimally achieved with a different suture configuration, such as by stacking crisscrossed oblique sutures, 1,3,9,14,18,33,40 also referred to as the cross-stitch suture technique. 14 Meniscal repair with cross-stitch suture orientation was shown in canines to restore native joint contact pressures and area at an equivalent standing angle of 20°to 30°of human knee flexion, 21,37,40 warranting investigation into its efficacy in human knees across a larger flexion arc.…”

Künstlicher Meniskusersatz

“…Nur ein kleiner Teil der Meniskusschäden lässt sich mittels einer Naht rekonstruieren. Aber auch hier sind die Langzeitergebnisse nicht immer befriedigend [2,3,4,5].…”