Tensile forces on sutures in the human lateral knee meniscus

Abstract

Tensile strength is the most often reported parameter in biomechanical investigations of meniscal repair techniques. However, the magnitude of the tensile forces that actually occur on repaired lesions is not clear. The purpose of this study was to investigate if tensile forces occur on repaired lateral meniscal lesions, which could exceed the failure strength of common repair techniques. In human knees (n = 6), vertical-longitudinal lesions 25 mm in length were created in the posterior horn of the lateral meniscus at a distance of 3 mm from the meniscosynovial junction and the popliteal hiatus. A braided steel wire, resembling a vertical suture, was inserted into the meniscal tissue and fitted with a force transducer. The knees were mounted in an apparatus, which simulated weight bearing and non-weight bearing conditions. Repeated measurements were conducted with both internal and external rotation at flexion angles of 0 degrees , 30 degrees , 60 degrees , 90 degrees and 120 degrees . Weight loading alone caused no tension on the suture. Combined flexion and rotation generated mean forces between 0.5 and 4.1 N. No significant effect of the flexion angle or direction of rotation was found. If a minimum strength of 10 N was assumed for the common meniscal repair techniques, the tensile forces were well below this limit under all circumstances (P < 0.001). These data indicate that, within the range of motion investigated, no significant tensile forces occur on longitudinal lateral lesions. Forces other than tension and biological factors are of greater importance for the healing. Therefore, the assessment of repair techniques should not be based on alone the ability to resist high distraction forces.

Biomechanical comparison of menisci from different species and artificial constructs

“…Uniaxial tension tests are used for evaluation of meniscal attachment function after transplantation [27], tensile forces are used to evaluate suture function in meniscus repair techniques [28,29]. The ball indention test characterizes the viscoelastic properties of meniscal tissue including stiffness, residual force and compression behavior [9,30] and we chose this test also in our biomechanical setup as the cyclic testing mimics physiological loading conditions.…”

Evaluation of novel biodegradable three‐armed‐ and hyper‐branched tissue adhesives in a meniscus explant model

“…Even though the adhesive strengths of our glues were lower than those of Dermabond ® , they do have clinical relevance. It has been shown that distraction forces acting on a torn meniscus in a cadaver knee model did not exceed 5–10 N when a load of 300 N was applied to the proximal end of the femoral part . Application of the force in such manner allowed to approximate the mean body weight less the weight of the leg itself in the setting of bipedal stance or squatting.…”

“…It has been shown that distraction forces acting on a torn meniscus in a cadaver knee model did not exceed 5-10 N when a load of 300 N was applied to the proximal end of the femoral part. 26,27 Application of the force in such manner allowed to approximate the mean body weight less the weight of the leg itself in the setting of bipedal stance or squatting. This means that the stress was not >50-100 kPa, during the recovery period after surgery the load on the knee might be even lower.…”

Development of a fast curing tissue adhesive for meniscus tear repair

“…The adhesive strength of the adhesive compositions (3.2–3.7 N) should be sufficient to hold the torn meniscus together during the period of healing, as it has been reported that in a cadaver knee model the distraction forces acting on a torn meniscus do not exceed 5–10 N when a load of 300 N is applied [21, 22]. During the recovery period after surgery, the load on the knee would be even lower.…”