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

Abstract

Background: Given the variety of suturing techniques for bucket-handle meniscal repair, it is important to assess which suturing technique best restores native biomechanics. Purpose/Hypothesis: To biomechanically compare vertical mattress and cross-stitch suture techniques, in single- and double-row configurations, in their ability to restore native knee kinematics in a bucket-handle medial meniscal tear model. The hypothesis was that there would be no difference between the vertical mattress and cross-stitch double-row suture techniques but that the double-row technique would provide significantly improved biomechanical parameters versus the single-row technique. Study Design: Controlled laboratory study. Methods: Ten matched pairs of human cadaver knees were randomly assigned to the vertical mattress (n = 10) or cross-stitch (n = 10) repair group. Each knee underwent 4 consecutive testing conditions: (1) intact, (2) displaced bucket-handle tear, (3) single-row suture configuration on the femoral meniscus surface, and (4) double-row suture configuration (repair of femoral and tibial meniscus surfaces). Knees were loaded with a 1000-N axial compressive force at 0°, 30°, 60°, 90°, and 120° of flexion for each condition. Resultant medial compartment contact area, average contact pressure, and peak contact pressure data were recorded. Results: Intact state contact area was not restored at 0° (P = .027) for the vertical double-row configuration and at 0° (P = .032), 60° (P < .001), and 90° (P = .007) of flexion for the cross-stitch double-row configuration. No significant differences were found in the average contact pressure and peak contact pressure between the intact state and the vertical mattress and cross-stitch repairs with single- and double-row configurations at any flexion angles. When the vertical and cross-stich repairs were compared across all flexion angles, no significant differences were observed in single-row configurations, but in double-row configurations, cross-stitch repair resulted in a significantly decreased contact area, average contact pressure, and peak contact pressure (all P < .001). Conclusion: Single- and double-row configurations of the vertical mattress and cross-stitch inside-out meniscal repair techniques restored native tibiofemoral pressure after a medial meniscal bucket-handle tear at all assessed knee flexion angles. Despite decreased contact area with a double-row configuration, mainly related to the cross-stitch repair, in comparison with the intact state, the cross-stitch double-row repair led to decreased pressure as compared with the vertical double-row repair. These findings are applicable only at the time of the surgery, as the biological effects of healing were not considered. Clinical Relevance: Medial meniscal bucket-handle tears may be repaired with the single- or double-row configuration of vertical mattress or cross-stitch sutures.

Continuous Vertical Inside-Out Versus Traditional Vertical Inside-Out Meniscal Repair: A Biomechanical Comparison

“…Nakama et al 21 performed a biomechanical study evaluating 10 pairs of cadaveric knees with bucket-handle tears. The knees were divided into 2 groups: group I had 10 vertical sutures, and group II had 10 vertical crossed sutures.…”

“…Interestingly, in the double-crossed suture group (femoral and tibial faces), the meniscal contact area and femorotibial pressure decreased compared with the single vertical suture group. 21…”

Hip Capsular Plication With Crossed Mattress Stitch Configuration for a Revision Hip Arthroscopy in the Setting of Capsular Insufficiency

“…Previous Technical Notes have described capsular closure with sutures tied in a parallel fashion 11 ; however, studies have demonstrated the mechanical advantage of using of a cross-mattress configuration. 12 Although standard capsular closure is adequate in most cases to restore normal hip biomechanics, capsular plication is necessary in patients with excess capsular laxity or microinstability of the joint. Although early results have been promising in our clinical practice, studies reporting medium- to long-term patient-reported outcomes are necessary to validate these results.…”

Meniscus Repair Techniques

“…4) are reasonable options for this tear pattern. A double-row cross-stitch configuration was recently shown to have decreased tibiofemoral contact pressure in comparison with a vertical double-row repair in a bucket-handle medial meniscal tears at time of initial repair 70. Care should be taken to alternate mattress sutures on both the superior and inferior surfaces of the meniscus to avoid a nonanatomic reduction of the tissue.…”