Radial Meniscal Tears Are Best Repaired by a Modified “Cross” Tie-Grip Suture Based on a Biomechanical Comparison of 4 Repair Techniques in a Porcine Model

Abstract

Background: The tie-grip suture can fix radial tears more rigidly than simple conventional sutures. However, one shortcoming is the residual gap at the central margin of the tear. The tie-grip suture was modified to address this issue and named the “cross tie-grip suture.” Purpose/Hypothesis: The purpose of this study was to compare the suture stability and strength among 4 suturing techniques: the original tie-grip, cross tie-grip, and 2 conventional sutures (double horizontal and cross). It was hypothesized that the cross tie-grip suture would show the least displacement and resist the greatest maximum load. Study Design: Controlled laboratory study. Methods: A total of 40 fresh-frozen porcine knees were dissected to acquire 80 menisci; 20 menisci were tested in each suture group. A radial tear was created at the middle third of the meniscal body. Repair was performed with the following: original tie-grip, cross tie-grip, double horizontal, and cross sutures. The mechanical strength of sutured menisci was evaluated using a tensile testing machine. All menisci underwent submaximal loading and load to failure. The gap distance and ultimate failure load were compared using analysis of variance. The failure mode was recorded after load-to-failure testing. Results: Displacement after 500 cycles was significantly smaller in the cross tie-grip group (0.4 ± 0.3 mm) compared with the tie-grip (0.9 ± 0.6 mm), double horizontal (1.2 ± 0.7 mm), and cross suture groups (1.4 ± 0.6 mm) ( P < .05). The ultimate failure load was significantly greater in the cross tie-grip (154.9 ± 29.0 N) and tie-grip (145.2 ± 39.1 N) groups compared with the double horizontal (81.2 ± 19.9 N) and cross suture groups (87.3 ± 17.7 N) ( P < .05). Tissue failure was the most common mode of failure in all groups. Conclusion: Upon repair of radial meniscal tears, the cross tie-grip suture showed less displacement compared with that of the tie-grip, double horizontal, and cross sutures and demonstrated equivalent load to failure to that of the tie-grip suture at time zero. Clinical Relevance: The cross tie-grip suture provided high resistance to displacement after repair of radial tears and may be advantageous in healing for radial meniscal tears.

Biomechanical comparison of vertical suture techniques for repairing radial meniscus tear

“…It also had a mean failure load and stiffness that were more than twice the values of the single vertical sutures in Beamer et al’s study [ 6 ]. Furthermore, compared to the double horizontal cross configuration in the study by Matsubara et al (which yielded a ultimate failure load of 78.9 ± 19.3 N and stiffness of 8.0 ± 1.5 N/mm) and the cross tie-grip technique that deploys parallel sutures but modified configurations in the study by Nakanishi et al (which yielded a ultimate failure load of 154.9 ± 29.0 N) [ 28 , 30 ], our double vertical and double vertical cross configuration yielded much stronger repair and better fixation. We reason that the double vertical and double vertical cross techniques both employ vertical stitches that are perpendicular to the radial fibrils, thus binding them more tightly at the site of tear [ 6 ].…”

Arthroscopic Centralization Using Knotless Anchors for Extruded Medial Meniscus

“…Hence, solely repairing tears cannot always reduce extrusion and restore meniscal function with the reported secure fixation methods. 12 , 13 , 14 , 15 …”

Increased Construct Stiffness With Meniscal Repair Sutures and Devices Increases the Risk of Cheese-Wiring During Biomechanical Load-to-Failure Testing

“…15,28 In our study, menisci were randomly assigned to the repair groups, and no further differentiation between medial and lateral samples was made, which is common practice in other studies as well. 7,23,31,34 Because this is a biomechanical evaluation of a worstcase scenario simulating a perpendicular load on singlepassage vertical meniscal repair, the results might not be unconditionally transferred to actual patients, bearing in mind complex knee kinematics including rotational and shear forces. 8 On the other hand, a particular strength of this work is that, to the best of our knowledge, the present study is the only available report investigating a potential relationship between construct stiffness and cheese-wiring under cyclic loading conditions.…”