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. 2018 Feb 6;13(2):e0192027.
doi: 10.1371/journal.pone.0192027. eCollection 2018.

Novel technique for repairing posterior medial meniscus root tears using porcine knees and biomechanical study

Jia-Lin Wu  1   2 , Chian-Her Lee  1   2 , Chan-Tsung Yang  3 , Chia-Ming Chang  4 , Guoan Li  5 , Cheng-Kung Cheng  3   4 , Chih-Hwa Chen  1   2 , Hsu-Shan Huang  6 , Yu-Shu Lai  3
Affiliations

Novel technique for repairing posterior medial meniscus root tears using porcine knees and biomechanical study

Jia-Lin Wu et al. PLoS One. .

Abstract

Transtibial pullout suture (TPS) repair of posterior medial meniscus root (PMMR) tears was shown to achieve good clinical outcomes. The purpose of this study was to compare biomechanically, a novel technique designed to repair PMMR tears using tendon graft (TG) and conventional TPS repair. Twelve porcine tibiae (n = 6 each) TG group: flexor digitorum profundus tendon was passed through an incision in the root area, created 5 mm postero-medially along the edge of the attachment area. TPS group: a modified Mason-Allen suture was created using no. 2 FiberWire. The tendon grafts and sutures were threaded through the bone tunnel and then fixed to the anterolateral cortex of the tibia. The two groups underwent cyclic loading followed by a load-to-failure test. Displacements of the constructs after 100, 500, and 1000 loading cycles, and the maximum load, stiffness, and elongation at failure were recorded. The TG technique had significantly lower elongation and higher stiffness compared with the TPS. The maximum load of the TG group was significantly lower than that of the TPS group. Failure modes for all specimens were caused by the suture or graft cutting through the meniscus. Lesser elongation and higher stiffness of the constructs in TG technique over those in the standard TPS technique might be beneficial for postoperative biological healing between the meniscus and tibial plateau. However, a slower rehabilitation program might be necessary due to its relatively lower maximum failure load.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1
(A) Illustration of the surgical technique for repair of the posterior medial meniscus root (PMMR) using a tendon graft. The posterior horn of the medial meniscus root was reconstructed with a 3-mm-diameter fresh flexor digitorum profundus tendon using a transosseous pullout technique. (B) Photograph demonstrating the complete constructs in the transverse plane.
Fig 2
Fig 2. Biomechanical test setup.
The clamp was equipped with corrugated jaw faces to prevent meniscus slippage, and the menisci were clamped medial to the sutures or grafts, respectively. The arrow indicates the modified Mason-Allen suture repair.
Fig 3
Fig 3
Failure modes of (A) the transtibial pullout suture (TPS) and (B) tendon graft (TG).
See this image and copyright information in PMC

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