Increased Construct Stiffness With Meniscal Repair Sutures and Devices Increases the Risk of Cheese-Wiring During Biomechanical Load-to-Failure Testing.

Abstract

BACKGROUND:

Cheese-wiring, the suture that cuts through the meniscus, is a well-known issue in meniscal repair. So far, contributing factors are neither fully understood nor sufficiently studied.

HYPOTHESIS/PURPOSE:

To investigate whether the construct stiffness of repair sutures and devices correlates with suture cut-through (cheese-wiring) during load-to-failure testing.

STUDY DESIGN:

Controlled laboratory study.

METHODS:

In 131 porcine menisci, longitudinal bucket-handle tears were repaired using either inside-out sutures (n = 66; No. 0 Ultrabraid, 2-0 Orthocord, 2-0 FiberWire, and 2-0 Ethibond) or all-inside devices (n = 65; FastFix360, Omnispan, and Meniscal Cinch). After cyclic loading, load-to-failure testing was performed. The mode of failure and construct stiffness were recorded. A receiver operating characteristic curve analysis was performed to define the optimal stiffness threshold for predicting meniscal repair failure by cheese-wiring. The 2-tailed t test and analysis of variance were used to test significance.

RESULTS:

Loss of suture fixation was the most common mode of failure in all specimens (58%), except for the Omnispan, which failed most commonly because of anchor pull-through. The Omnispan demonstrated the highest construct stiffness (30.8 ± 3.5 N/mm), whereas the Meniscal Cinch (18.0 ± 8.8 N/mm) and Ethibond (19.4 ± 7.8 N/mm) demonstrated the lowest construct stiffness. The Omnispan showed significantly higher stiffness compared with the Meniscal Cinch (P < .001) and Ethibond (P = .02), whereas the stiffness of the Meniscal Cinch was significantly lower compared with that of the FiberWire (P = .01), Ultrabraid (P = .04), and FastFix360 (P = .03). While meniscal repair with a high construct stiffness more often failed by cheese-wiring, meniscal repair with a lower stiffness failed by loss of suture fixation, knot slippage, or anchor pull-through. Meniscal repair with a stiffness >26.5 N/mm had a 3.6 times higher risk of failure due to cheese-wiring during load-to-failure testing (95% CI, 1.4-8.2; P < .0001).

CONCLUSION:

Meniscal repair using inside-out sutures and all-inside devices with a higher construct stiffness (>26.5 N/mm) was more likely to fail through suture cut-through (cheese-wiring) than that with a lower stiffness (≤26.5 N/mm).

CLINICAL RELEVANCE:

This is the first study investigating the impact of construct stiffness on meniscal repair failure by suture cut-through (cheese-wiring).

• Authors: Sebastian Müller, Tanja Schwenk, Michael de Wild, Dimitris Dimitriou, Claudio Rosso
• Journal: Orthopaedic journal of sports medicine (Orthop J Sports Med) Vol. 9 Issue 6 Pg. 23259671211015674 (Jun 2021) ISSN: 2325-9671 [Print] United States
• PMID: 34189149 (Publication Type: Journal Article)
• Copyright: © The Author(s) 2021.