“Horizontal butterfly” technique in repair of radial meniscus tears: A biomechanical study

Abstract

IntroductionRadial meniscus tears are seen in young patients, especially with anterior cruciate ligament ruptures. Repair of complete radial meniscus tear is necessary for the meniscus functions. The most important factor for success of the meniscus repair is primary stability, but it is still unknown which technique is ideal repair technique.AimWe developed a new suture technique named Horizontal Butterfly (HB). In this novel technique the contact between meniscal tissue and suture is more than Horizontal Loop (HL) that routinely used today. So, we think that this technique will provide better fixation than HL. We aimed to compare 2 repair techniques (HB vs. HL) using human lateral menisci biomechanically with cyclic loading and load to failure tests.Material-methodWe used 22 intact lateral meniscus obtained from patients that operated (total knee replacement) for varus gonarthrosis in our clinic. All menisci were cut radially. In the first group (n:11) menisci were repaired with standard horizontal loop technique, and in the second group (n:11) horizontal butterfly technique were used for repair. All specimens were tested with load to failure test after cyclic loading test (500 cycle X 5–30 N).ResultsBoth groups have similar failure load (71,4 ± 17,52 N vs. 77,9 ± 28,49 N; p:0,559) and stiffness (24,46 ± 19,19 N vs. 24,48 ± 15,87 N; p:0,818). HB group has less peak displacement (6,26 ± 1,24 mm vs. 8,4 ± 1,92 mm; p:0,010).ConclusionThis novel repair technique decreases the amount of displacement according to standard technique while as strong as standard technique routinely used. In this way; we believe that it will increase the rate of healing in clinical use.

The all-inside all-suture technique demonstrated better biomechanical behaviors in meniscus radial tear repair

“…Recently, a new all‐inside all‐suture repair construct (AIAS) (Knee Scorpion™, Arthrex, Naples, FL) using cross‐stitch techniques has been developed and used in clinic. Several studies have been performed to understand the biomechanical characteristics of “Horizontal butterfly” technique and cross‐stitch techniques [4, 24], however, the comparison of biomechanical characteristics of AIAS with AISAH and inside‐out has not been studied in radial meniscus tear repair. The hypothesis of this study was that this new AIAS technique would be superior to the other two techniques in terms of biomechanical behaviors.…”

Biomechanical comparison of vertical suture techniques for repairing radial meniscus tear

“…The inside‐out/outside‐in technique passing horizontal stitches has been commonly used today to treat various types of meniscal tear, however, it is still inconclusive whether this method is the optimal approach to repair radial meniscal tear [4, 6, 20, 24, 27, 33]. In light of the limitations of the traditional inside‐out double horizontal suture used for repairing radial tears [7], novel repair approaches using horizontal suture orientations were developed and tested.…”

Biomechanical Comparison of the Simple Suture Technique, Meniscal Matrix-Assisted Repair, and a Novel Meniscus Cap Suture Technique for Complex Meniscal Repair

“…The loading force and the number of cycles-as adopted from similar designed previous studies-have produced suture ruptures as a common failure mode in all 3 groups. 2,8,9,[11][12][13]15,28 There is a contrast with the above findings and the failure mode of currently available meniscal scaffolds. In all specimens tested by Gwinner et al, 14 the failure mode of the Collagen Meniscus Scaffold was a complete disruption of the scaffold integrity.…”