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Elongation and Structural Properties of Meniscal Repair Using Suture Techniques in Distraction and Shear Force Scenarios

Biomechanical Evaluation Using a Cyclic Loading Protocol

Thore Zantop, MD^*,, Kira Temmig, Andre Weimann, MD, Ann Kathleen Eggers, Michael J. Raschke, MD and Wolf Petersen, MD

From the Department of Trauma, Hand, and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany, and the Department of Orthopaedic Surgery, University Hospital Schleswig-Holstein, Campus Kiel, Germany

^* Address correspondence to Thore Zantop, MD, Department of Trauma, Hand, and Reconstructive Surgery, Westfälische Wilhelms-Universität Muenster, Waldeyerstr 1, D-48149 Muenster, Germany (e-mail: thore.zantop{at}ukmuenster.de).

Background: Most biomechanical studies on meniscal repairs have focused on testing distraction scenarios to evaluate structural properties of the repaired meniscus. An application of shear forces might replicate the in vivo situation more closely.

Hypothesis: In the shear force scenario, meniscal repair using a vertical suture technique will result in significantly less elongation when subjected to a cyclic loading protocol than that resulting from a horizontal suture technique.

Study Design: Controlled laboratory study.

Methods: In fresh-frozen porcine menisci (n = 10 in each group), horizontal and vertical 2.0 Ethibond suturing techniques were tested in distraction and shear force scenarios. Elongation after 1000 cycles between 5 and 20 N and the structural properties such as stiffness, yield load, maximum load to failure, and failure mode were evaluated using a testing machine at a rate of 12.5 mm/s.

Results: In the distraction force scenario, no statistically significant difference in elongation after cyclic loading was found between specimens repaired with vertical or horizontal suture techniques. After 1000 cycles of cyclic loading in the shear force scenario, the horizontal suturing revealed significantly less elongation (2.8 ± 1.1 mm) than did the vertical suture technique (4.6 ± 2.0 mm). No statistically significant difference in yield and maximum load was found (P > .05).

Conclusion: The results of the present study do not support the authors’ hypothesis. In the shear force test, horizontal sutures were superior to vertical suture techniques.

Clinical Relevance: Meniscal repair with horizontal suture techniques can withstand elongation due to shear forces more effectively than can vertical mattress sutures.

Key Words: meniscal fixation techniques • meniscal healing • shear forces • biomechanics • bucket-handle tear • healing • cyclic loading

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