Pullout strength of meniscal repair after cyclic loading: comparison of vertical, horizontal, and oblique suture techniques

Abstract

This in vitro biomechanical study with cyclic loading compared the pullout strength of vertical, horizontal, and oblique sutures used for meniscal lesion repair. Following repair of vertical longitudinal lesions created in bovine medial menisci, three groups of seven specimens (vertical, horizontal, and oblique sutures) underwent cyclic loading in a randomized test order (5 mm/min, cycling between 5 and 50 N at 1 Hz for 100 cycles) prior to load to failure testing (5 mm/min). Displacement did not differ between groups during cyclic or load to failure testing. Construct stiffness during cyclic testing was superior for the oblique suture (6.9 +/- 1.5 N/mm, P = 0.007) and the vertical suture (6.4 +/- 7 N/mm, P = 0.03) groups compared to the horizontal suture group (4.4 +/- 0.52 N/mm). The oblique suture (171.9 +/- 25.9 N, P < 0.0001) and the vertical suture (145.9 +/- 32.3 N, P = 0.001) groups displayed superior load at failure compared to the horizontal suture group (88.8 +/- 8.2 N). Construct stiffness during load to failure testing did not differ between groups. Suture rupture was the failure mode for all specimens of the oblique suture group. Suture rupture was the failure mode for 57% (4/7) of the vertical suture group with the remaining specimens (3/7, 43%) failing from intact suture pullout through meniscal tissue. All horizontal suture group specimens failed by intact suture pulling through meniscal tissue. With comparable stiffness during cyclic testing, comparable load at failure as vertical sutures, and less evidence of intact suture pullout through the meniscus, an oblique suture technique may combine the beneficial characteristics of vertical (superior biomechanical strength) and horizontal (ease of application, longer sutures with a tendency to cover a larger meniscal tissue area) suture-repair techniques.

A Biomechanical Comparison of All-Inside Meniscus Repair Techniques

“…Therefore, this should provide the most pertinent information regarding the biomechanical properties. We used a single vertical suture because it is well known that the strength of the vertical loop suture is superior to that of the horizontal suture due to the perpendicular orientation of the meniscal fibers relative to the repair device [21]. …”

The modified cross-suture technique for unilateral pulled-out anchor during all-inside meniscal repair

“…In clinical practice, some oblique or cross-suture methods have been applied in the treatment of radial tears of the meniscus and have achieved good results [30][31][32] . Biomechanical studies have shown [33] that oblique sutures have the dual advantage of vertical sutures (superior biomechanical strength) and horizontal sutures (ease of application, longer sutures with a tendency to cover a larger meniscal tissue area). According to such theoretical and practical results, we hypothesize that if it is applied to the remediation of unilateral suture anchor pulling out of an all-inside meniscal repair system, the clinical efficacy of this method may be improved.…”

Comparison of Contact Mechanics of Three Meniscal Repair Techniques and Partial Meniscectomy in Cadaveric Dog Stifles

“…Several in vitro animal and human studies have shown that the vertical and oblique suture repairs have superior load to failure compared with horizontal repair. [37][38][39][40] Until further mechanical studies are performed on meniscal suture techniques in dog menisci we would recommend a vertical or cruciate suture repair.…”