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Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy 8/2018

26.07.2017 | Knee

A simple cinch is superior to a locking loop for meniscus root repair: a human biomechanical comparison of suture constructs in a transtibial pull-out model

verfasst von: Aaron J. Krych, Nick R. Johnson, Isabella T. Wu, Patrick A. Smith, Michael J. Stuart

Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy | Ausgabe 8/2018

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Abstract

Purpose

To determine the cyclic displacement and ultimate failure loads of two clinically relevant suture configurations for repair of medial and lateral meniscus root tears.

Methods

A total of 10 matched pair fresh-frozen, human meniscus specimens were randomly assigned to either simple cinch or locking loop meniscus–suture fixation techniques for transtibial pull-out repair in either medial (n = 10 matched pairs) or lateral (n = 10 matched pairs) meniscal root tears. The menisci were subjected to cyclic tensioning at 10–30 N for 1000 cycles at 0.5 Hz, and then post-cycling load to failure was performed at a tensile rate of 0.5 mm/s.

Results

For both the medial and lateral meniscus, there was significantly less displacement with the cinch stitch at 100, 500 and 1000 cycle counts (p < 0.05). In respect to ultimate load, there was no significant difference in type of repair between the two suture configurations. When comparing ultimate load to failure from the medial to the lateral side, the ultimate load to failure was significantly greater for both suture configurations in the lateral meniscus root repair (p < 0.05). However, there was no significant difference in cyclic displacement between the medial and lateral meniscus.

Conclusions

The cinch stitch was significantly better at resisting displacement compared to the locking loop stitch configuration, and had similar ultimate load to failure. The lateral meniscus root repair construct has higher failure loads compared to the medial meniscus, independent of suture configuration.
Literatur
1.
Zurück zum Zitat Ahn JH, Jeong HJ, Lee YS, Park JH, Lee JW, Park J-H et al (2015) Comparison between conservative treatment and arthroscopic pull-out repair of the medial meniscus root tear and analysis of prognostic factors for the determination of repair indication. Arch Orthop Trauma Surg 135:1265–1276CrossRefPubMed Ahn JH, Jeong HJ, Lee YS, Park JH, Lee JW, Park J-H et al (2015) Comparison between conservative treatment and arthroscopic pull-out repair of the medial meniscus root tear and analysis of prognostic factors for the determination of repair indication. Arch Orthop Trauma Surg 135:1265–1276CrossRefPubMed
2.
Zurück zum Zitat Allaire R, Muriuki M, Gilbertson L, Harner CD (2008) Biomechanical consequences of a tear of the posterior root of the medial meniscus. Similar to total meniscectomy. J Bone Joint Surg Am 90:1922–1931CrossRefPubMed Allaire R, Muriuki M, Gilbertson L, Harner CD (2008) Biomechanical consequences of a tear of the posterior root of the medial meniscus. Similar to total meniscectomy. J Bone Joint Surg Am 90:1922–1931CrossRefPubMed
3.
Zurück zum Zitat Anz AW, Branch EA, Saliman JD (2014) Biomechanical comparison of arthroscopic repair constructs for meniscal root tears. Am J Sports Med 42:2699–2706CrossRefPubMed Anz AW, Branch EA, Saliman JD (2014) Biomechanical comparison of arthroscopic repair constructs for meniscal root tears. Am J Sports Med 42:2699–2706CrossRefPubMed
4.
Zurück zum Zitat Bhatia S, LaPrade CM, Ellman MB, LaPrade RF (2014) Meniscal root tears: significance, diagnosis, and treatment. Am J Sports Med 42:3016–3030CrossRefPubMed Bhatia S, LaPrade CM, Ellman MB, LaPrade RF (2014) Meniscal root tears: significance, diagnosis, and treatment. Am J Sports Med 42:3016–3030CrossRefPubMed
5.
Zurück zum Zitat Chung KS, Ha JK, Yeom CH, Ra HJ, Jang HS, Choi SH et al (2015) Comparison of clinical and radiologic results between partial meniscectomy and refixation of medial meniscus posterior root tears: a minimum 5-year follow-up. Arthroscopy 31:1941–1950CrossRefPubMed Chung KS, Ha JK, Yeom CH, Ra HJ, Jang HS, Choi SH et al (2015) Comparison of clinical and radiologic results between partial meniscectomy and refixation of medial meniscus posterior root tears: a minimum 5-year follow-up. Arthroscopy 31:1941–1950CrossRefPubMed
6.
Zurück zum Zitat Feucht MJ, Grande E, Brunhuber J, Rosenstiel N, Burgkart R, Imhoff AB et al (2015) Biomechanical evaluation of different suture materials for arthroscopic transtibial pull-out repair of posterior meniscus root tears. Knee Surg Sports Traumatol Arthrosc 23:132–139CrossRefPubMed Feucht MJ, Grande E, Brunhuber J, Rosenstiel N, Burgkart R, Imhoff AB et al (2015) Biomechanical evaluation of different suture materials for arthroscopic transtibial pull-out repair of posterior meniscus root tears. Knee Surg Sports Traumatol Arthrosc 23:132–139CrossRefPubMed
7.
Zurück zum Zitat Forkel P, Reuter S, Sprenker F, Achtnich A, Herbst E, Imhoff A et al (2015) Different patterns of lateral meniscus root tears in ACL injuries: application of a differentiated classification system. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 23:112–118CrossRef Forkel P, Reuter S, Sprenker F, Achtnich A, Herbst E, Imhoff A et al (2015) Different patterns of lateral meniscus root tears in ACL injuries: application of a differentiated classification system. Knee Surg Sports Traumatol Arthrosc Off J ESSKA 23:112–118CrossRef
8.
Zurück zum Zitat Koenig JH, Ranawat AS, Umans HR, Difelice GS (2009) Meniscal root tears: diagnosis and treatment. Arthroscopy 25:1025–1032CrossRefPubMed Koenig JH, Ranawat AS, Umans HR, Difelice GS (2009) Meniscal root tears: diagnosis and treatment. Arthroscopy 25:1025–1032CrossRefPubMed
10.
Zurück zum Zitat Krych AJ, Reardon PJ, Johnson NR, Mohan R, Peter L, Levy BA et al (2017) Non-operative management of medial meniscus posterior horn root tears is associated with worsening arthritis and poor clinical outcome at 5-year follow-up. Knee Surg Sports Traumatol Arthrosc 25(2):383–389. doi:10.1007/s00167-016-4359-8 CrossRefPubMed Krych AJ, Reardon PJ, Johnson NR, Mohan R, Peter L, Levy BA et al (2017) Non-operative management of medial meniscus posterior horn root tears is associated with worsening arthritis and poor clinical outcome at 5-year follow-up. Knee Surg Sports Traumatol Arthrosc 25(2):383–389. doi:10.​1007/​s00167-016-4359-8 CrossRefPubMed
11.
Zurück zum Zitat LaPrade CM, Foad A, Smith SD, Turnbull TL, Dornan GJ, Engebretsen L et al (2015) Biomechanical consequences of a nonanatomic posterior medial meniscal root repair. Am J Sports Med 43:912–920CrossRefPubMed LaPrade CM, Foad A, Smith SD, Turnbull TL, Dornan GJ, Engebretsen L et al (2015) Biomechanical consequences of a nonanatomic posterior medial meniscal root repair. Am J Sports Med 43:912–920CrossRefPubMed
12.
Zurück zum Zitat LaPrade CM, Jansson KS, Dornan G, Smith SD, Wijdicks CA, LaPrade RF (2014) Altered tibiofemoral contact mechanics due to lateral meniscus posterior horn root avulsions and radial tears can be restored with in situ pull-out suture repairs. J Bone Joint Surg Am 96:471–479CrossRefPubMed LaPrade CM, Jansson KS, Dornan G, Smith SD, Wijdicks CA, LaPrade RF (2014) Altered tibiofemoral contact mechanics due to lateral meniscus posterior horn root avulsions and radial tears can be restored with in situ pull-out suture repairs. J Bone Joint Surg Am 96:471–479CrossRefPubMed
13.
Zurück zum Zitat LaPrade CM, LaPrade MD, Turnbull TL, Wijdicks CA, LaPrade RF (2015) Biomechanical evaluation of the transtibial pull-out technique for posterior medial meniscal root repairs using 1 and 2 transtibial bone tunnels. Am J Sports Med 43:899–904CrossRefPubMed LaPrade CM, LaPrade MD, Turnbull TL, Wijdicks CA, LaPrade RF (2015) Biomechanical evaluation of the transtibial pull-out technique for posterior medial meniscal root repairs using 1 and 2 transtibial bone tunnels. Am J Sports Med 43:899–904CrossRefPubMed
14.
Zurück zum Zitat Lee DW, Jang SH, Ha JK, Kim JG, Ahn JH (2013) Meniscus root refixation technique using a modified Mason-Allen stitch. Knee Surg Sports Traumatol Arthrosc 21:654–657CrossRefPubMed Lee DW, Jang SH, Ha JK, Kim JG, Ahn JH (2013) Meniscus root refixation technique using a modified Mason-Allen stitch. Knee Surg Sports Traumatol Arthrosc 21:654–657CrossRefPubMed
15.
Zurück zum Zitat Liodakis E, Dratzidis A, Kraemer M, Hurschler C, Krettek C, Hawi A et al (2016) The lasso-loop, lasso-mattress and simple-cinch stitch for arthroscopic rotator cuff repair: are there biomechanical differences? Arch Orthop Trauma Surg 136(11):1581–1585CrossRefPubMed Liodakis E, Dratzidis A, Kraemer M, Hurschler C, Krettek C, Hawi A et al (2016) The lasso-loop, lasso-mattress and simple-cinch stitch for arthroscopic rotator cuff repair: are there biomechanical differences? Arch Orthop Trauma Surg 136(11):1581–1585CrossRefPubMed
16.
Zurück zum Zitat Mitchell R, Pitts R, Kim YM, Matava MJ (2016) Medial meniscal root avulsion: a biomechanical comparison of 4 different repair constructs. Arthroscopy 32:111–119CrossRefPubMed Mitchell R, Pitts R, Kim YM, Matava MJ (2016) Medial meniscal root avulsion: a biomechanical comparison of 4 different repair constructs. Arthroscopy 32:111–119CrossRefPubMed
17.
Zurück zum Zitat Pagnani MJ, Cooper DE, Warren RF (1991) Extrusion of the medial meniscus. Arthroscopy 7:297–300CrossRefPubMed Pagnani MJ, Cooper DE, Warren RF (1991) Extrusion of the medial meniscus. Arthroscopy 7:297–300CrossRefPubMed
18.
Zurück zum Zitat Pula DA, Femia RE, Marzo JM, Bisson LJ (2014) Are root avulsions of the lateral meniscus associated with extrusion at the time of acute anterior cruciate ligament injury?: a case control study. Am J Sports Med 42:173–176CrossRefPubMed Pula DA, Femia RE, Marzo JM, Bisson LJ (2014) Are root avulsions of the lateral meniscus associated with extrusion at the time of acute anterior cruciate ligament injury?: a case control study. Am J Sports Med 42:173–176CrossRefPubMed
20.
Zurück zum Zitat Starke C, Kopf S, Grobel KH, Becker R (2010) The effect of a nonanatomic repair of the meniscal horn attachment on meniscal tension: a biomechanical study. Arthroscopy 26:358–365CrossRefPubMed Starke C, Kopf S, Grobel KH, Becker R (2010) The effect of a nonanatomic repair of the meniscal horn attachment on meniscal tension: a biomechanical study. Arthroscopy 26:358–365CrossRefPubMed
21.
Zurück zum Zitat Starke C, Kopf S, Lippisch R, Lohmann CH, Becker R (2013) Tensile forces on repaired medial meniscal root tears. Arthroscopy 29:205–212CrossRefPubMed Starke C, Kopf S, Lippisch R, Lohmann CH, Becker R (2013) Tensile forces on repaired medial meniscal root tears. Arthroscopy 29:205–212CrossRefPubMed
22.
Zurück zum Zitat Sung JH, Ha JK, Lee DW, Seo WY, Kim JG (2013) Meniscal extrusion and spontaneous osteonecrosis with root tear of medial meniscus: comparison with horizontal tear. Arthroscopy 29:726–732CrossRefPubMed Sung JH, Ha JK, Lee DW, Seo WY, Kim JG (2013) Meniscal extrusion and spontaneous osteonecrosis with root tear of medial meniscus: comparison with horizontal tear. Arthroscopy 29:726–732CrossRefPubMed
Metadaten
Titel
A simple cinch is superior to a locking loop for meniscus root repair: a human biomechanical comparison of suture constructs in a transtibial pull-out model
verfasst von
Aaron J. Krych
Nick R. Johnson
Isabella T. Wu
Patrick A. Smith
Michael J. Stuart
Publikationsdatum
26.07.2017
Verlag
Springer Berlin Heidelberg
Erschienen in
Knee Surgery, Sports Traumatology, Arthroscopy / Ausgabe 8/2018
Print ISSN: 0942-2056
Elektronische ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-017-4652-1

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