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

Abstract

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.

Second-Look Arthroscopic Evaluation of Healing Rates After Arthroscopic Repair of Meniscal Tears: A Systematic Review and Meta-analysis

“…This action is dependent on the longitudinal orientation of the intrameniscal circumferential fibers and results in the generation of hoop tension in the meniscus as a vertical load is applied. 1 Regarding the integrity of circumferential fibers in meniscal tears, horizontal tears may be in a better situation than radial and root tears.…”

Inside-Out Repair for Radial Meniscus Tears

“…1,2 Depending on the nature of the tear, repair may allow for restoration of near normal knee biomechanics. 3 Specifically, radial tears have been shown to increase focal stress on the articular cartilage equivalent to complete meniscectomy, and therefore, have been linked to early onset arthrosis.…”