Biomechanical evaluation of arthroscopic all-inside meniscus repairs

Abstract

Viper is a new device for arthroscopically all-inside meniscal repairing. In previous studies about Viper device, procedures were not applied arthroscopically despite this device has been designed for arthroscopic application. In this study, we evaluated primary fixation strength of arthroscopically applied meniscal repair using Viper device to obtain better clinical relevance. Two centimeter in length meniscal tear 2-3 mm far from periferic edge of medial meniscus of 50 calves were created arthroscopically. The menisci were divided into five groups including 10 menisci in each. In group 1, tears were repaired by outside-in vertical loop suture technique with No: 0 PDS. Tears were fixed by all-inside vertical suture by using Viper device with No: 0 PDS in group 2. In meniscal implant groups, RapidLoc, H-Fix, and Clearfix were applied in groups 3,4, and 5, respectively. Primary fixation strength of repairing techniques were evaluated with bio-mechanical testing machine. Fixation strengths determined in groups 1 and 2 were detected as 145 +/- 13 and 136 +/- 33 N, respectively. There was no difference in pull-out strength between groups 1 and 2. Fixation strengths in these two groups were significantly higher compared to groups 3, 4, and 5. There was no significant difference between group 3 (33 +/- 6 N) and 5 (28 +/- 6 N) in terms of fixation strengths whereas fixation strengths of these two groups were significantly higher compared to group 4 (20 +/- 3 N) (P = 0.005, P = 0.018, respectively). All-inside vertical suture technique using Viper device revealed comparable primary fixation strength with outside-in vertical suture technique for meniscal repair. We suggest that the Viper device is safe and reliable for meniscal repair.

Surgical Techniques for Knee Joint Repair

“…72 The all inside technique has shown that fixation with the most recent repair devices is as strong and as reliable as outside-in technique. 73 Currently, all three techniques are considered effective options for tear fixation and can be used with equal clinical effectiveness.…”

The Postoperative Meniscus: Anatomical, Operative, and Imaging Considerations

“…These devices can create repairs similar in strength to outside-in techniques and stronger than other allinside techniques. 55,57 The inside-out technique remains the gold standard for meniscal repair, 58 especially for large tears and buckethandle tears that require a significant number of sutures. A systematic review, comparing inside-out to all-inside repairs, demonstrated no differences in healing rates, functional outcomes, and complication rates.…”

Meniscal injuries: evaluation and management � current review

“…Fourth generation repair devices allow the placement of sutures in the meniscus without using an incision or a fixator system 17 . Gunes et al 33 , in their mechanical study, concluded that these repair devices outcome studies have demonstrated that repairs of the meniscus performed concurrently with ACL reconstruction are more successful than repairs done in ACL-intact knees. Therefore, it is generally recommended that ACL reconstruction and meniscal repair should be done concurrently 29,30 .…”