Modified cruciate suture technique for arthroscopic meniscal repair: a technical note

Abdelkafy, Ashraf

doi:10.1007/s00167-007-0287-y

Cited by 5 publications

(7 citation statements)

References 21 publications

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“…Some anatomical and biomechanical explanations for this high failure rate include blood supply and motion [25–27], but also repair technique factors such as high fixation strength, stability, and tension [28]. The fixation strength required to maintain the meniscus in a reduced position during ambulation and rehabilitation should be considered for long, complex, degenerative tears, and tears, especially in older patients [29]. However, the meniscus has inherent activity during motion of the knee joint [30, 31].…”

Section: Discussionmentioning

confidence: 99%

An arthroscopic repair technique for meniscal tear using a needle and suture: outside-in transfer all-inside repair

Wang

Xiong

Tang

et al. 2019

BMC Musculoskelet Disord

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BackgroundAt present, most repair techniques for meniscal tears fix the meniscus directly over the capsule. This changes the normal anatomy and biomechanics and limits the activity of the meniscus during motion. We introduce an arthroscopic repair technique by suturing the true meniscus tissue without the capsule and subcutaneous tissue.MethodsAfter confirmation of a tear, a custom-designed meniscal repair needle first penetrates percutaneously, crossing the capsular portion and the torn meniscus, and exits from the femoral surface of one side of the torn meniscus. Then a No. 2 PDS suture is passed through the needle and retrieved through the arthroscopy portal. Next, the needle is withdrawn to the synovial margin of the meniscus and is reinserted, exiting the femoral surface of the other side of the torn meniscus. The suture is pulled out through the same portal with a grasper. Finally, arthroscopic knotting is performed.ResultsWe had 149 cases of meniscal tears repaired with this outside-in transfer all-inside technique since July 2016.ConclusionsIt is a simple, minimally invasive, and economical procedure that is appropriate for most parts of the meniscus except the posterior horn of the lateral meniscus, and it can be used to fix torn meniscus tissue firmly while also preserving the inherent activity of the meniscus.

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Section: Discussionmentioning

confidence: 99%

An arthroscopic repair technique for meniscal tear using a needle and suture: outside-in transfer all-inside repair

Wang

Xiong

Tang

et al. 2019

BMC Musculoskelet Disord

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“…It is pulled through the loop all the way outside a portal. Arthroscope is in the anterolateral portal outside-in technique, and a modification was later described [2].…”

Section: Introductionmentioning

confidence: 99%

“…Techniques of arthroscopic meniscal repair include inside‐out, outside‐in and all‐inside. The gold standard for meniscal repair is the vertical suture repair technique [2, 27].…”

Section: Introductionmentioning

confidence: 99%

The concept of three-dimensional hold of both circumferential and radial collagen fibres of the meniscus

Abdelkafy

2013

Knee Surg Sports Traumatol Arthrosc

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Collagen fibres of the meniscus arrange into two main orientations: circumferential fibres parallel to the long axis of the meniscus and radial fibres perpendicular to the long axis of the meniscus. Meniscal sutures are placed either in vertical or in horizontal orientations. Vertical sutures better hold circumferential fibres because it encircles them like a rope holding a bunch of tree branches. In the same manner, horizontal sutures better hold radial fibres. The "Simplified Cruciate Suture" consists of two vertical oblique sutures. Placing two vertical sutures in an oblique orientation captures greater meniscal tissue volume, holds and grasps both circumferential and radial collagen fibres of the meniscus into a three-dimensional plane with eventual high fixation strength of the repaired meniscal tear. Simplified cruciate suture is indicated for the repair of long bucket handle tears where it is placed in the middle of the tear like an anchor, and additional vertical and horizontal sutures are placed anterior and posterior to it as needed. Level of evidence V.

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“…34 The vertical mattress suture pattern for meniscal repairs is performed because of its reported biomechanical superiority over horizontal mattress sutures. 13,20,23,25,39,40,42 However, it remains unknown whether restoration of native joint kinematics and contact pressures may be more optimally achieved with a different suture configuration, such as by stacking crisscrossed oblique sutures, 1,3,9,14,18,33,40 also referred to as the cross-stitch suture technique. 14 Meniscal repair with cross-stitch suture orientation was shown in canines to restore native joint contact pressures and area at an equivalent standing angle of 20°to 30°of human knee flexion, 21,37,40 warranting investigation into its efficacy in human knees across a larger flexion arc.…”

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confidence: 99%

“…Therefore, the purpose of this study was to biomechanically compare the vertical mattress and cross-stitch suture techniques and the single-and double-row configurations in a buckethandle medial meniscal tear model, analyzing contact area, average contact pressure, and peak contact pressure. Our hypotheses were that (1) there would be no difference between the vertical mattress and cross-stitch double-row suture techniques and (2) the double-row technique would provide significantly improved biomechanical parameters (contact area, average contact pressure, and peak contact pressure) as compared with the single-row technique.…”

mentioning

confidence: 99%

Biomechanical Comparison of Vertical Mattress and Cross-stitch Suture Techniques and Single- and Double-Row Configurations for the Treatment of Bucket-Handle Medial Meniscal Tears

et al. 2019

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Background: Given the variety of suturing techniques for bucket-handle meniscal repair, it is important to assess which suturing technique best restores native biomechanics. Purpose/Hypothesis: To biomechanically compare vertical mattress and cross-stitch suture techniques, in single- and double-row configurations, in their ability to restore native knee kinematics in a bucket-handle medial meniscal tear model. The hypothesis was that there would be no difference between the vertical mattress and cross-stitch double-row suture techniques but that the double-row technique would provide significantly improved biomechanical parameters versus the single-row technique. Study Design: Controlled laboratory study. Methods: Ten matched pairs of human cadaver knees were randomly assigned to the vertical mattress (n = 10) or cross-stitch (n = 10) repair group. Each knee underwent 4 consecutive testing conditions: (1) intact, (2) displaced bucket-handle tear, (3) single-row suture configuration on the femoral meniscus surface, and (4) double-row suture configuration (repair of femoral and tibial meniscus surfaces). Knees were loaded with a 1000-N axial compressive force at 0°, 30°, 60°, 90°, and 120° of flexion for each condition. Resultant medial compartment contact area, average contact pressure, and peak contact pressure data were recorded. Results: Intact state contact area was not restored at 0° (P = .027) for the vertical double-row configuration and at 0° (P = .032), 60° (P < .001), and 90° (P = .007) of flexion for the cross-stitch double-row configuration. No significant differences were found in the average contact pressure and peak contact pressure between the intact state and the vertical mattress and cross-stitch repairs with single- and double-row configurations at any flexion angles. When the vertical and cross-stich repairs were compared across all flexion angles, no significant differences were observed in single-row configurations, but in double-row configurations, cross-stitch repair resulted in a significantly decreased contact area, average contact pressure, and peak contact pressure (all P < .001). Conclusion: Single- and double-row configurations of the vertical mattress and cross-stitch inside-out meniscal repair techniques restored native tibiofemoral pressure after a medial meniscal bucket-handle tear at all assessed knee flexion angles. Despite decreased contact area with a double-row configuration, mainly related to the cross-stitch repair, in comparison with the intact state, the cross-stitch double-row repair led to decreased pressure as compared with the vertical double-row repair. These findings are applicable only at the time of the surgery, as the biological effects of healing were not considered. Clinical Relevance: Medial meniscal bucket-handle tears may be repaired with the single- or double-row configuration of vertical mattress or cross-stitch sutures.

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Modified cruciate suture technique for arthroscopic meniscal repair: a technical note

Cited by 5 publications

References 21 publications

An arthroscopic repair technique for meniscal tear using a needle and suture: outside-in transfer all-inside repair

An arthroscopic repair technique for meniscal tear using a needle and suture: outside-in transfer all-inside repair

The concept of three-dimensional hold of both circumferential and radial collagen fibres of the meniscus

Biomechanical Comparison of Vertical Mattress and Cross-stitch Suture Techniques and Single- and Double-Row Configurations for the Treatment of Bucket-Handle Medial Meniscal Tears

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