Cyclic Test Comparison of All-Inside Device and Inside-Out Sutures for Radial Meniscus Lesion Repair: An In Vitro Porcine Model Study

Division of Sports Medicine, Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky, U.S.A.
Arthroscopy The Journal of Arthroscopic and Related Surgery (Impact Factor: 3.19). 10/2012; 28(12). DOI: 10.1016/j.arthro.2012.06.015
Source: PubMed

ABSTRACT PURPOSE: To compare biomechanical fixation and gapping characteristics of a new all-inside meniscus repair method for radial meniscus lesion repair versus conventional inside-out suture repair under submaximal cyclic loading and load-to-failure test conditions. METHODS: Fresh-frozen porcine tibiae with attached lateral menisci and joint capsules were harvested and stored for 48 hours at -20°C. After thawing for 12 hours, equivalent-size healthy specimens were randomly assigned to 2 groups of 8 specimens each. Standardized radial lesions were repaired with the Sequent device (ConMed Linvatec, Largo, FL) (group 1) or conventional inside-out suturing with No. 2-0 braided polyester suture (group 2). Repaired specimens were placed in custom clamps and mounted on a servohydraulic device. After a 2-N preload, specimens were cycled from 5 to 20 N (0.1 Hz), before undergoing 1,000 submaximal loading cycles between 5 and 20 N (0.5 Hz). A 40-second delay at 100, 500, and 1,000 cycles enabled digital photographs to be taken for gapping measurement determination. Specimens then underwent load-to-failure testing (12.5 mm/s). Fixation failure mode was documented. RESULTS: Group displacement did not differ after 1, 100, 500, and 1,000 submaximal loading cycles. Group peak gapping did not differ at 100, 500, and 1,000 submaximal loading cycles. Load at failure and displacement and stiffness during load-to-failure testing did not differ between groups. During load-to-failure testing, all-inside specimens failed by implant dislodgement from the meniscus periphery whereas the inside-out repaired specimens failed by suture rupture. CONCLUSIONS: Under controlled in vitro biomechanical test conditions, the all-inside device provided radial meniscus lesion fixation that was comparable, but not superior, to conventional inside-out suturing. CLINICAL RELEVANCE: The all-inside radial lateral meniscus lesion repair method may provide comparable fixation to conventional inside-out suturing without the need for additional incisions and their associated neurovascular injury risks.

  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND:A tear of the posterior medial meniscus root (PMMR) is increasingly recognized as a serious knee joint injury. Several suture techniques for arthroscopic transtibial pull-out repair have been described; however, only limited data about the biomechanical properties of these techniques are currently available. HYPOTHESIS:There are significant differences between the tested suture techniques, with more complex suture configurations providing superior biomechanical properties. STUDY DESIGN:Controlled laboratory study. METHODS:A total of 40 porcine medial menisci were randomly assigned to 1 of 4 groups (10 specimens each) according to suture technique: two simple stitches (TSS), horizontal mattress suture (HMS), modified Mason-Allen suture (MMA), and two modified loop stitches (TLS). Meniscus-suture constructs were subjected to cyclic loading followed by load-to-failure testing in a servohydraulic material testing machine. RESULTS:During cyclic loading, the HMS and TLS groups showed a significantly higher displacement after 100, 500, and 1000 cycles compared with the TSS and MMA groups. After 1000 cycles, the highest displacement was found for the TLS group, with significant differences compared with all other groups. During load-to-failure testing, the highest maximum load and yield load were observed for the MMA group, with statistically significant differences compared with the TSS and TLS groups. With regard to stiffness, the TSS and MMA groups showed significantly higher values compared with the HMS and TLS groups. CONCLUSION:The MMA technique provided the best biomechanical properties with regard to cyclic loading and load-to-failure testing. The TSS technique seems to be a valuable alternative. Both the HMS and TLS techniques have the disadvantage of lower stiffness and higher displacement during cyclic loading. CLINICAL RELEVANCE:Using a MMA technique may improve healing rates and avoid progressive extrusion of the medial meniscus after transtibial pull-out repair of PMMR tears. The TSS technique may be used as an alternative that is easier to perform, but a more careful rehabilitation program is possibly necessary to avoid early failure.
    The American Journal of Sports Medicine 09/2013; 41(12). DOI:10.1177/0363546513502464 · 4.70 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: This in vitro biomechanical study using a porcine model compared peripheral longitudinal vertical meniscus lesion (PLVML) outside-in suture repair fixation strength using either interrupted or continuous "N" configuration No. 2-0 braided polyester sutures. Porcine lateral menisci were randomly assigned to group 1 (continuous) or group 2 (interrupted). Standardized PLVMLs were created in each specimen. Repaired specimens were placed in a specially designed clamp and loaded into a servohydraulic device. Specimens underwent preconditioning for 10 cycles (0.1 Hz, 5 to 20 N) and 500 submaximal loading cycles (0.5 Hz, 5 to 20 N), before load-to-failure testing (12.5 mm/s). A 30-second pause after preconditioning and after 10, 100, and 500 submaximal loading cycles enabled standardized digital photographs to be taken for gapping measurement determination. The failure mode was documented. Displacement and gapping during preconditioning and submaximal loading cycles did not differ between groups. Group 1 withstood a greater failure load (mean, 118.3 N; 95% confidence interval [CI], 97.2 to 139.4 N) than group 2 (mean, 63.7 N; 95% CI, 51.2 to 76.2 N) (P < .0001) and displacement during load-to-failure testing (mean, 5.3 mm; 95% CI, 4.2 to 6.5 mm) than group 2 (mean, 3.2 mm; 95% CI, 2.1 to 4.3 mm) (P = .005). Group 1 failed by suture breakage or suture pulling through tissue, whereas group 2 primarily failed by knot slippage (P < .0001). Group displacement and gapping differences were not observed after 500 submaximal loading cycles. PLVMLs repaired with a continuous N configuration, however, withstood greater load at failure and greater displacement before failure than repairs that used interrupted sutures. Continuous suture in an N configuration may improve PLVML repair fixation strength.
    Arthroscopy The Journal of Arthroscopic and Related Surgery 10/2013; 29(12). DOI:10.1016/j.arthro.2013.08.026 · 3.19 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND:Many all-inside suture-based devices are currently available, including the Meniscal Cinch, FasT-Fix, Ultra FasT-Fix, RapidLoc, MaxFire, and CrossFix System. These different devices have been compared in various configurations, but to our knowledge, the Sequent meniscal repair device, which applies running sutures, has not been compared with the Ultra FasT-Fix, nor has it been compared with its suture, No. 0 Hi-Fi, using an inside-out repair technique. PURPOSE:To assess the quality of the meniscal repair, all new devices should be compared with the gold standard: the inside-out repair. To that end, this study aims to compare the biomechanical characteristics of running sutures delivered by the Sequent meniscal repair device with 2 vertical mattress sutures applied using the Ultra FasT-Fix device and with 2 vertical mattress sutures using an inside-out repair technique with No. 0 Hi-Fi suture. STUDY DESIGN:Controlled laboratory study. METHODS:Paired (medial and lateral), fresh-frozen porcine menisci were randomly assigned to 1 of 3 groups: Sequent (n = 17), Ultra FasT-Fix (n = 19), and No. 0 Hi-Fi inside-out repair (n = 20). Bucket-handle tears were created in all menisci and were subjected to repair according to their grouping. Once repaired, the specimens were subjected to cyclic loading (100, 300, and 500 cycles), followed by loading to failure. RESULTS:The Sequent and Ultra FasT-Fix device repairs and the suture repair exhibited low initial displacements. The Sequent meniscal repair device demonstrated the lowest displacement in response to cyclic loading. No. 0 Hi-Fi suture yielded the highest load to failure. CONCLUSION:With the development of the next generation of all-inside meniscal repair devices, surgeons may use these findings to select the method best suited for their patients. CLINICAL RELEVANCE:The Sequent meniscal repair device displays the least amount of displacement during cyclic loading but has a similar failure load to other devices.
    The American Journal of Sports Medicine 10/2013; 42(1). DOI:10.1177/0363546513505190 · 4.70 Impact Factor