Meniscus root tears: state of the art

Hantouly, Ashraf T.; Aminake, Ghislain; Khan, Anfal Sher; Ayyan, Muhammad; Olory, Bruno; Zikria, Bashir; Al-Khelaifi, Khalid

doi:10.1007/s00264-024-06092-w

Cited by 7 publications

(1 citation statement)

References 37 publications

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“…Similar to the osteochondral interface, this is achieved through various hierarchical structural and compositional elements that contribute to stress reduction at the insertion. − Rather than insertion failures, bone avulsions or soft tissue ruptures tend to occur. Nonetheless, the insertion is at risk of overuse injuries and lesions, clinically referred to as “enthesopathies”. − Some clinical cases of insertion failures, such as rotator cuff tears, anterior cruciate ligament (ACL) ruptures, and meniscus root tears remain unresolved due to the difficulty of the soft tissue to sufficiently integrate into the bone. ,− Statistics show that repaired tendon insertions are susceptible to failure at a rate as high as 94% . Therefore, to achieve integrated and functional insertions, it is necessary to understand the multiscale biological, structural, and mechanical incorporation of native soft tissue into bone.…”

Section: Introductionmentioning

confidence: 99%

Compositional, Structural, and Biomechanical Properties of Three Different Soft Tissue–Hard Tissue Insertions: A Comparative Review

Liu,

Jiang,

Liu

et al. 2024

ACS Biomater. Sci. Eng.

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Connective tissue attaches to bone across an insertion with spatial gradients in components, microstructure, and biomechanics. Due to regional stress concentrations between two mechanically dissimilar materials, the insertion is vulnerable to mechanical damage during joint movements and difficult to repair completely, which remains a significant clinical challenge. Despite interface stress concentrations, the native insertion physiologically functions as the effective load-transfer device between soft tissue and bone. This review summarizes tendon, ligament, and meniscus insertions cross-sectionally, which is novel in this field. Herein, the similarities and differences between the three kinds of insertions in terms of components, microstructure, and biomechanics are compared in great detail. This review begins with describing the basic components existing in the four zones (original soft tissue, uncalcified fibrocartilage, calcified fibrocartilage, and bone) of each kind of insertion, respectively. It then discusses the microstructure constructed from collagen, glycosaminoglycans (GAGs), minerals and others, which provides key support for the biomechanical properties and affects its physiological functions. Finally, the review continues by describing variations in mechanical properties at the millimeter, micrometer, and nanometer scale, which minimize stress concentrations and control stretch at the insertion. In summary, investigating the contrasts between the three has enlightening significance for future directions of repair strategies of insertion diseases and for bioinspired approaches to effective soft−hard interfaces and other tough and robust materials in medicine and engineering.

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Section: Introductionmentioning

confidence: 99%

Compositional, Structural, and Biomechanical Properties of Three Different Soft Tissue–Hard Tissue Insertions: A Comparative Review

Liu,

Jiang,

Liu

et al. 2024

ACS Biomater. Sci. Eng.

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Biomechanical analysis of four different meniscus suturing techniques for posterior meniscal root pull‐out repair: A human cadaveric study

Chang,

Yang,

Lin

2024

J. exp. orthop.

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PurposeTo compare the biomechanical properties of the slip‐knot technique with three other transtibial pullout suture repair constructs for meniscal root tears.MethodThirty‐two fresh‐frozen cadaveric menisci were randomly allocated to four meniscus‐suture fixation constructs: Two simple‐sutures (TSS), two slip‐knot (TSK) sutures, two cinch‐loop (TCL) sutures, and two modified Mason–Allen (TMMA) sutures. Cyclic loading from 5 to 20 N was conducted for 1000 cycles at 0.5 Hz, and then loaded to failure at 0.5 mm/s. Parametric data (displacement during cyclic loading, ultimate load, yield load, and displacement at failure) were analysed using a one‐way analysis of variance (ANOVA), whereas nonparametric data (stiffness) were analysed using the Kruskal–Wallis test.ResultsAfter 1000 cycles, the TCL construct significantly displaced the most (mean ± SD, 6.78 ± 1.32 mm; p < 0.001), followed by the TMMA (2.83 ± 0.90 mm), TSK (2.33 ± 0.57 mm), and TSS (2.03 ± 0.62 mm) groups. On ultimate failure load, there was no significant difference between the TSK group (123.48 ± 27.24 N, p > 0.05) and the other three groups (TSS, 94.65 ± 25.33 N; TMMA, 168.38 ± 23.24 N; TCL, 170.54 ± 57.32 N); however, it exhibited the least displacement (5.53 ± 1.25 mm) which was significantly shorter than those of the TCL (11.82 ± 4.25 mm, p < 0.001) and TMMA (9.53 ± 2.18 mm, p = 0.03) constructs. No significant difference in stiffness was observed among the four meniscus‐suture constructs.ConclusionThe slip‐knot technique has proven to be a simple, yet robust and stable meniscal root fixation option; moreover, it exhibited superiority over the more complex modified Mason–Allen suture construct in resisting displacement at the ultimate failure load.Level of EvidenceNot applicable.

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Development and validation of a biomechanically fidelic surgical training knee model

Bennett,

Foroutan,

Fairweather

et al. 2024

Journal Orthopaedic Research

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Knee arthroplasty technique is constantly evolving and the opportunity for surgeons to practice new techniques is currently highly dependent on the availability of cadaveric specimens requiring certified facilities. The high cost, limited supply, and heterogeneity of cadaveric specimens has increased the demand for synthetic training models, which are currently limited by a lack of biomechanical fidelity. Here, we aimed to design, manufacture, and experimentally validate a synthetic knee surgical training model which reproduces the flexion dependent varus‐valgus (VV) and anterior‐posterior (AP) mechanics of cadaveric knees, while maintaining anatomic accuracy. A probabilistic finite element modeling approach was employed to design physical models to exhibit passive cadaveric VV and AP mechanics. Seven synthetic models were manufactured and tested in a six‐degree‐of‐freedom hexapod robot. Overall, the synthetic models exhibited cadaver‐like VV and AP mechanics across a wide range of flexion angles with little variation between models. In the extended position, two models showed increased valgus rotation (<0.5°), and three models showed increased posterior tibial translation (<1.7 mm) when compared to the 95% confidence interval (CI) of cadaveric measurements. At full flexion, all models showed VV and AP mechanics within the 95% CI of cadaveric measurements. Given the repeatable mechanics exhibited, the knee models developed in this study can be used to reduce the current reliance on cadaveric specimens in surgical training.

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Meniscus root tears: state of the art

Cited by 7 publications

References 37 publications

Compositional, Structural, and Biomechanical Properties of Three Different Soft Tissue–Hard Tissue Insertions: A Comparative Review

Compositional, Structural, and Biomechanical Properties of Three Different Soft Tissue–Hard Tissue Insertions: A Comparative Review

Biomechanical analysis of four different meniscus suturing techniques for posterior meniscal root pull‐out repair: A human cadaveric study

Development and validation of a biomechanically fidelic surgical training knee model

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