All-inside meniscal repair devices compared with their matched inside-out vertical mattress suture repair: introducing 10,000 and 100,000 loading cycles.

Abstract

BACKGROUND:

All-inside arthroscopic meniscal repairs are favored by most clinicians because of their lower complication rate and decreased morbidity compared with inside-out techniques. Until now, only 1000 cycles have been used for biomechanical testing.

HYPOTHESIS:

All-inside meniscal repairs will show inferior biomechanical response to cyclic loading (up to 100,000 cycles) and load-to-failure testing compared with inside-out suture controls.

STUDY DESIGN:

Controlled laboratory study.

METHODS:

Bucket-handle tears in 72 porcine menisci were repaired using the Omnispan and Fast-Fix 360 (all-inside devices) and Orthocord 2-0 and Ultrabraid 2-0 sutures (matched controls). Initial displacement, displacement after cyclic loading (100, 500, 1000, 2000, 5000, 10,000, and 100,000 cycles) between 5 and 20 N, ultimate load to failure, and mode of failure were recorded, as well as stiffness.

RESULTS:

Initial displacement and displacement after cyclic loading were not different between the groups. The Omnispan repair demonstrated the highest load-to-failure force (mean ± SD, 151.3 ± 21.5 N) and was significantly stronger than all the other constructs (Orthocord 2-0, 105.5 ± 20.4 N; Ultrabraid 2-0, 93.4 ± 22.5 N; Fast-Fix 360, 76.6 ± 14.2 N) (P < .0001 for all). The Orthocord vertical inside-out mattress repair was significantly stronger than the Fast-Fix 360 repair (P = .003). The Omnispan (30.8 ± 3.5 N/mm) showed significantly higher stiffness compared with the Ultrabraid 2-0 (22.9 ± 6.9 N/mm, P < .0001) and Fast-Fix 360 (23.7 ± 3.9 N/mm, P = .001). The predominant mode of failure was suture failure.

CONCLUSION:

All-inside meniscal devices show comparable biomechanical properties compared with inside-out suture repair in cyclic loading, even after 100,000 cycles.

CLINICAL RELEVANCE:

Eight to 10 weeks of rehabilitation might not pose a problem for all repairs in this worst-case scenario.

• Authors: Claudio Rosso, Sebastian Müller, Daniel M Buckland, Tanja Schwenk, Simon Zimmermann, Michael de Wild, Victor Valderrabano
• Journal: The American journal of sports medicine (Am J Sports Med) Vol. 42 Issue 9 Pg. 2226-33 (Sep 2014) ISSN: 1552-3365 [Electronic] United States
• PMID: 24966304 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2014 The Author(s).

Topics

• Animals
• Biomechanical Phenomena
• Materials Testing
• Menisci, Tibial (surgery)
• Orthopedic Procedures (instrumentation)
• Random Allocation
• Stress, Mechanical
• Suture Techniques
• Swine
• Tibial Meniscus Injuries