Skip to main content
SpringerLink
Log in

Horizontal suture placement influences meniscal repair fixation strength

  • Knee
  • Published:
Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

This in vitro biomechanical study investigated the influence of horizontal suture placement distance from the medial meniscal lesion repair site on fixation characteristics during submaximal cyclic and load to failure test conditions.

Methods

Eighteen cadaveric (20–45 years of age) medial menisci with intact joint capsules were harvested within 24–48 h after death and divided into two groups of 9 specimens each for biomechanical testing. A 2.0-cm-long antero-posterior vertical longitudinal lesion was created with a #15 scalpel 2.0–3.0 mm from the outer edge of each meniscus. Menisci were repaired using #2–0 suture material with two horizontal suture loops placed either 1.0 mm (Group 1) or 3.0 mm (Group 2) from the lesion site. Following repair, the lesion was extended completely through the meniscal horns so that no tissue secured the repair, only the two horizontal suture loops representing a “worst-case” testing scenario. Following repair, specimens were placed in a servo hydraulic device using a pair of 1.2-mm-diameter steel wire loops and underwent submaximal cyclic loading between 5 and 50 N (1 Hz) for 500 cycles prior to load to failure testing (5 mm/min crosshead speed, 20 Hz data collection). An alpha level of P < 0.05 was selected to indicate statistical significance.

Results

Five of nine (55.6 %) Group 1 specimens did not complete submaximal cyclic testing. All Group 2 specimens completed submaximal cyclic testing (Fisher’s exact test P = 0.029). Statistically significant mean group differences were not observed for displacement during submaximal cyclic loading (Group 1 = 5.0 ± 1.5 mm and Group 2 = 5.7 ± 1.6 mm) or for construct stiffness during load to failure testing (Group 1 = 50.1 ± 6.3 N/mm and Group 2 = 52.6 ± 11.9 N/mm). Group 2 displayed greater mean load at failure (112.1 ± 40.8 N vs. 72.7 ± 11.2 N, P = 0.02) and mean displacement at failure (11.1 ± 2.2 mm vs. 7.6 ± 1.4 mm, P = 0.03) than Group 1.

Conclusions

Horizontal sutures placed slightly farther away from the meniscus lesion displayed superior repair fixation than sutures placed closer to the lesion. The superior biomechanical meniscal repair fixation provided by capturing greater tissue volume may enable safe earlier participation in functional exercise activities. Studies are needed to verify these findings in vivo.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Baratz ME, Fu FH, Mengato R (1986) Meniscal tears: the effect of meniscectomy and of repair on intraarticular contact areas and stress in the human knee. A preliminary report. Am J Sports Med 14:270–275

    Article  PubMed  CAS  Google Scholar 

  2. Barber FA, Herbert MA, Schroeder A, Aziz-Jacobo J, Sutker MJ (2009) Biomechanical testing of new meniscal repair techniques containing ultra high-molecular weight polyethylene suture. Arthroscopy 25:959–967

    Article  PubMed  Google Scholar 

  3. Barber FA, Stone RG (1985) Meniscal repair. An arthroscopic technique. J Bone Joint Surg Br 7:39–41

    Google Scholar 

  4. Becker R, Starke C, Heymann M, Nebelung W (2002) Biomechanical properties undercyclic loading of seven meniscus repair techniques. Clin Orthop Relat Res 400:236–245

    Article  PubMed  Google Scholar 

  5. Brewer BW, van Raalte JL, Linder DE (1993) Athletic identity: Hercules’ muscle or Achilles heel? Int J Sport Psychol 24:237–254

    Google Scholar 

  6. Brucker PU, Favre P, Puskas GJ, von Campe A, Meyer DC, Koch PP (2010) Tensile and shear loading stability of all-inside meniscal repairs: an in vitro biomechanical evaluation. Am J Sports Med 38:1838–1844

    Article  PubMed  Google Scholar 

  7. Fisher SR, Markel DC, Koman JD, Atkinson TS (2002) Pull-out and shear failure strengths of arthroscopic meniscal repair systems. Knee Surg Sports Traumatol Arthrosc 10:294–299

    PubMed  Google Scholar 

  8. Hsieh HH, Walker PS (1976) Stabilizing mechanisms of the loaded and unloaded knee joint. J Bone Joint Surg Am 58:87–93

    PubMed  CAS  Google Scholar 

  9. Johnson RJ, Kettelkamp DB, Clark W, Leaverton P (1974) Factors affecting late results after meniscectomy. J Bone Joint Surg Am 56:719–729

    PubMed  CAS  Google Scholar 

  10. Kocabey Y, Nyland J, Isbell WM, Caborn DNM (2004) Patient outcomes following T-Fix meniscal repair and a modifiable, progressive rehabilitation program, a retrospective study. Arch Orthop Trauma Surg 124:592–596

    Article  PubMed  Google Scholar 

  11. Kocabey Y, Taser O, Hapa O, Guclu A, Bozdag E, Sunbuloglu E, Doral MN (2011) Meniscal repair using large diameter horizontal sutures increases fixation strength: an in vitro study. Knee Surg Sports Traumatol Arthrosc 19:202–206

    Article  PubMed  Google Scholar 

  12. Kocabey Y, Taser O, Nyland J, Doral MN, Demirhan M, Caborn DN, Sarban S (2006) Pullout strength of meniscal repair after cyclic loading: comparison of vertical, horizontal, and oblique suture techniques. Knee Surg Sports Traumatol Arthrosc 14:998–1003

    Article  PubMed  Google Scholar 

  13. Krause WR, Pope MH, Johnson RJ, Wilder DG (1976) Mechanical changes in the knee after meniscectomy. J Bone Joint Surg Am 58:599–604

    PubMed  CAS  Google Scholar 

  14. Kurosawa H, Fukubayashi T, Nakajima H (1980) Load-bearing mode of the knee joint: physical behavior of the knee joint with or without menisci. Clin Orthop Relat Res 149:283–290

    PubMed  Google Scholar 

  15. Lamprakis AA, Fortis AP, Kostopoulos V, Vlasis K (2009) Biomechanical testing of a shape memory alloy suture in a meniscal suture model. Arthroscopy 25:632–638

    Article  PubMed  Google Scholar 

  16. Langford JL, Webster KE, Feller JA (2009) A prospective longitudinal study to assess psychological changes following anterior cruciate ligament reconstruction surgery. Br J Sports Med 43:377–381

    Article  PubMed  CAS  Google Scholar 

  17. MacConaill MA (1950) The movements of bones and joints 3. The synovial fluid and its assistants. J Bone Joint Surg Br 32:244–252

    PubMed  Google Scholar 

  18. McDermott ID, Richards SW, Hallam P, Tavares S, Lavelle JR, Amis AA (2003) A biomechanical study of four different meniscal repair systems, comparing pull-out strengths and gapping under cyclic loading. Knee Surg Sports Traumatol Arthrosc 11:23–29

    PubMed  CAS  Google Scholar 

  19. Noyes FR, Heckmann TP, Barber-Westin SD (2012) Meniscus repair and transplantation: a comprehensive update. J Orthop Sports Phys Ther 42:274–290

    PubMed  Google Scholar 

  20. Pujol N, Barbier O, Boisrenoult P, Beaufils P (2011) Amount of meniscal resection after failed meniscal repair. Am J Sports Med 39:1648–1652

    Article  PubMed  Google Scholar 

  21. Richards DP, Barber FA, Herbert MA (2008) Meniscal tear biomechanics: loads across meniscal tears in human cadaveric knees. Orthopedics 31:347–350

    Article  PubMed  Google Scholar 

  22. Voloshin AS, Wosk J (1983) Shock absorption of meniscectomized and painful knees: a comparative in vivo study. J Biomed Eng 5:157–161

    Article  PubMed  CAS  Google Scholar 

  23. Zantop T, Temmig K, Weimann A, Eggers KA, Raschke MJ, Petersen W (2006) Elongation and structural properties of meniscal repair using suture techniques in distraction and shear force scenarios. Am J Sports Med 34:799–805

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, Kocaeli Acibadem Hospital, Kocaeli, Turkey

    Yavuz Kocabey

  2. Department of Orthopaedics and Traumatology, Fulya Acibadem Hospital, Fulya, Turkey

    Omer Taser

  3. Division of Sports Medicine, Department of Orthopaedic Surgery, University of Louisville, 550 South Jackson St. 1st Floor ACB, Louisville, KY, USA

    John Nyland

  4. Ministry of Forensic Medicine, Istanbul, Turkey

    Haluk Ince & Feyzi Sahin

  5. Istanbul Technical University, Istanbul, Turkey

    Emin Sunbuloglu & Gokhan Baysal

Authors
  1. Yavuz Kocabey
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Omer Taser
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. John Nyland
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Haluk Ince
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Feyzi Sahin
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Emin Sunbuloglu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Gokhan Baysal
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to John Nyland.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kocabey, Y., Taser, O., Nyland, J. et al. Horizontal suture placement influences meniscal repair fixation strength. Knee Surg Sports Traumatol Arthrosc 21, 615–619 (2013). https://doi.org/10.1007/s00167-012-1995-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00167-012-1995-5

Keywords

Search

Navigation