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

Abstract

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

Tensile and Shear Loading Stability of All-Inside Meniscal Repairs

“…However, this significant difference of elongation at the repair site between horizontal and vertical outside-in suture techniques did not influence the stiffness and the maximum load of the corresponding repaired meniscus construct in the shear compared with the axial distraction force scenario, 20 which is consistent with our results. Contrary to Zantop et al, 20 we could demonstrate a markedly and significantly reduced stiffness of the Ethibond 2.0 vertical as well as the horizontal loops in the shear compared to the tensile load scenario. Conflicting stiffness and the unequal peak levels of the load to failure in both studies may be explained by the variable test protocol (cyclic vs noncyclic), suture technique (outsidein vs inside-out), test speed (12.5 mm/s vs 5 mm/min), test temperature (room vs body temperature), and animal model (porcine vs bovine).…”

“…Zantop et al 20 have investigated the structural properties of a horizontal and vertical meniscal suture repair technique in an axial distraction and shear force scenario under cyclic loading. Interestingly, they found that meniscal repair with a horizontal suture technique can withstand elongation caused by shear forces more effectively than a vertical suture technique, which may be important for limitation of meniscal tissue displacement at the meniscal repair site during the healing process.…”

“…6 Limitations of our study are the isolated testing configuration using a uniaxial and continuously acting tensile or shear load setup, which represents the loading conditions of the repaired meniscus in vivo only in parts, as the meniscal repairs are also exposed to compression and cyclic load patterns. 6,15,18,20 Usually, critical axial distraction loads do not occur at the meniscal repair site because compression loads counteract the distraction loads within the healing period if correct rehabilitation is performed. However, unpredictable loading of the knee within the rehabilitation period by undesired squatting, pivoting, or twisting motions may cause deleterious distraction at the repair site.…”

Horizontal suture placement influences meniscal repair fixation strength

“…They reported that meniscal repair using horizontal sutures sustained less elongation than vertical sutures when subjected to shear forces [7,23]. Reduced elongation or displacement during healing is vital to the success or failure of arthroscopic meniscal repair.…”

Suture materials and subsequent wound strength

“…Several studies have looked at suture technique and wound strength. In a study by Zantop et al (2006), it was found that meniscal repair with horizontal suture techniques can withstand elongation due to shear forces more effectively than can vertical mattress sutures. Poole et al (1984) found that with laparotomy wounds, the simple interrupted technique was unaffected by suture tension but was generally inferior to the running stitch in terms of wound-bursting strength.…”