The all-inside all-suture technique demonstrated better biomechanical behaviors in meniscus radial tear repair
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The all‑inside all‑suture technique demonstrated better biomechanical behaviors in meniscus radial tear repair Timothy Doig1 · Paul Fagan2 · Todd Frush1,2 · Lisa Lovse1 · Chaoyang Chen2 · Stephen Lemos1,2 Received: 13 November 2019 / Accepted: 20 May 2020 © European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2020
Abstract Purpose The purpose of this study was to evaluate the effectiveness of three constructs and techniques for repair of radial tears of the meniscus. Methods Thirty fresh frozen porcine menisci were divided equally into three groups consisting of (1) inside-out repair group, (2) a commonly used all-inside suture with anchor hybrid repair construct (AISAH) (Meniscal Cinch™), and (3) an all-inside all-suture repair construct (AIAS) (Knee Scorpion™). Radial tears were created and repaired and then the menisci were secured to the materials testing machine. Both cyclic loading and load-to-failure testing were performed. The displacement, stiffness, response to cyclic loading, and mode of failure were recorded and analyzed statistically. Results The displacement after cyclic loading (DACL) of the Cinch repair construct group was significantly higher than that of the inside-out repair construct group (p = 0.000) and AIAS repair construct (p = 0.000). There was not a statistical difference of DACL between inside-out and AIAS groups (n.s.). The inside-out construct failed at a significantly higher load than the AISAH repair construct (p = 0.000) and AIAS construct (p = 0.006). The AIAS construct failed at a significantly higher load than the AISAH repair construct (p = 0.009). The AIAS had a higher stiffness than AISAH (p = 0.047). The AIAS had a higher load at 3 mm protrusion than AISAH (p = 0.034). Conclusion The AIAS repair construct had better biomechanical behaviors than AISAH construct and inside-out repair technique. Inside-out sutures and AIAS repair construct had similar biomechanical responses to cyclic loading. The AIAS can be used for meniscus tear surgical repair with less damage to peri-meniscus tissues. Keywords Meniscus repair · Biomechanics · Radial tear · Knee scorpion · Meniscal cinch
Introduction Complete radial tears of the meniscus result in negative effects as showed in total meniscectomy [8, 12, 29, 31], which has been recognized as a risk factor in the development of osteoarthritis of the knee [12, 30]. Radial tears are increasingly common, showing a 10–23% incidence overall * Chaoyang Chen [email protected] * Stephen Lemos [email protected] 1
Detroit Medical Center Sports Medicine, DMC Sports Medicine Orthopaedic Surgery Fellowship Program, 3990 John R Street, PO Box 137, Detroit, MI 48201, USA
Department of Orthopaedic Surgery and Sports Medicine, Detroit Medical Center, 3990 John R Street, PO Box 137, Detroit, MI 48201, USA
2
and notably a 10% incidence in children [11, 23, 32]. The disruption of the peripheral fibers of the torn meniscus leads to a decrease in resistance to hoop stresses that compromise the meniscus and joint surface [8, 1
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