Strategies for repair of radial tears close to the meniscal rim--biomechanical analysis with a cyclic loading protocol

Abstract

Background: Lateral meniscectomy contributes to early-onset osteoarthritis. Biomechanical properties of sutures repairs for complete radial meniscal tears remain unknown.

Hypothesis: Double horizontal suture techniques for repair of radial meniscal tears with a shorter distance from the meniscal rim provide significantly higher structural properties than do comparable single-suture techniques with a wider distance from the meniscal rim.

Study design: Controlled laboratory study.

Methods: In 55 fresh-frozen porcine menisci, standardized complete radial meniscal tears were repaired with different distances from the meniscal rim and tear edges and with different numbers of sutures. In group A, the suture was 4 mm from the tear and 8 mm from the meniscal rim; group B, 2 mm from tear; group C, 2 mm from tear, 12 mm from rim; group D, double-loop technique, 2 mm from tear, 5 mm and 10 mm from rim; group E, longitudinal tear sutured with 1 loop, 8 mm from rim, and 4 mm between stitches. The specimens were cyclically loaded 1000 times between 5 and 20 N and loaded to failure.

Results: All repaired constructs survived the cyclic loading protocol. Compared with the single-loop techniques, the double-loop technique (group D) showed a significantly higher maximum load and yield load and significantly lower displacement after 1000 cycles. Compared with group B, group C had a higher displacement after 1000 cycles (P < .05), and its stiffness showed a descriptive negative trend (P = .09). Displacement after cycling testing in group C was higher than in groups B and D (P < .05).

Conclusion: Repair of radial meniscal tears with a second suture and shorter distance from the meniscal rim has a positive influence on primary stability. Different distances from tear edges apparently have no influence on structural properties.

Clinical relevance: Horizontal sutures for repair of radial meniscal tears provide high stability and can be enhanced with a second horizontal suture and shorter distance from the meniscal rim.