Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 23, Issue 1, pp 132–139 | Cite as

Biomechanical evaluation of different suture materials for arthroscopic transtibial pull-out repair of posterior meniscus root tears

  • Matthias J. Feucht
  • Eduardo Grande
  • Johannes Brunhuber
  • Nikolaus Rosenstiel
  • Rainer Burgkart
  • Andreas B. ImhoffEmail author
  • Sepp Braun
Experimental Study



To evaluate the biomechanical properties of four different suture materials for arthroscopic transtibial pull-out repair of posterior meniscus root tears, with special focus on the meniscus–suture interface.


Forty fresh-frozen lateral porcine menisci were used. The posterior meniscus root was sutured in a standardized fashion with a simple stitch using four different suture materials: group A, No. 2 PDS™; group B, No. 2 Ethibond™; group C, No. 2 FiberWire™; and group D, 2-mm Fibertape™. Meniscus–suture constructs were subjected to cyclic loading followed by load-to-failure testing using a servo-hydraulic material testing machine.


During cyclic loading, group D showed a significantly higher displacement after 100, 500, and 1,000 cycles compared to group A (p < 0.001, p = 0.001, and p = 0.001), and a significantly higher displacement after 100 and 500 cycles compared to group B (p = 0.010 and p = 0.045). Group C showed a significantly higher displacement compared to group A after 100 cycles (p = 0.008). The highest maximum load was observed in group D, with significant differences compared to group A (p = 0.013). Group B showed a significantly higher stiffness compared to group A (p = 0.023), and both group C and group D showed a significantly higher stiffness compared to group A and group B (p < 0.001).


None of the evaluated suture materials provided clearly superior properties over the others during both cyclic loading and load-to-failure testing. Based on the results of this study, FiberWire™ may be the preferred suture material for transtibial pull-out repair of posterior meniscus root tears because of comparably low displacement during cyclic loading and high values for maximum load and stiffness. In the clinical setting, FiberWire™ may improve healing rates and avoid progressive extrusion of the meniscus after transtibial pull-out repair of posterior meniscus root tears.


Meniscus root Root repair Pull-out repair Suture material FiberWire FiberTape 


  1. 1.
    Abbi G, Espinoza L, Odell T, Mahar A, Pedowitz R (2006) Evaluation of 5 knots and 2 suture materials for arthroscopic rotator cuff repair: very strong sutures can still slip. Arthroscopy 22(1):38–43PubMedCrossRefGoogle Scholar
  2. 2.
    Ahn JH, Lee YS, Yoo JC, Chang MJ, Park SJ, Pae YR (2010) Results of arthroscopic all-inside repair for lateral meniscus root tear in patients undergoing concomitant anterior cruciate ligament reconstruction. Arthroscopy 26(1):67–75PubMedCrossRefGoogle Scholar
  3. 3.
    Ahn JH, Wang JH, Lim HC, Bae JH, Park JS, Yoo JC, Shyam AK (2009) Double transosseous pull out suture technique for transection of posterior horn of medial meniscus. Arch Orthop Trauma Surg 129(3):387–392PubMedCrossRefGoogle Scholar
  4. 4.
    Ahn JH, Wang JH, Yoo JC, Noh HK, Park JH (2007) A pull out suture for transection of the posterior horn of the medial meniscus: using a posterior trans-septal portal. Knee Surg Sports Traumatol Arthrosc 15(12):1510–1513PubMedCrossRefGoogle Scholar
  5. 5.
    Allaire R, Muriuki M, Gilbertson L, Harner CD (2008) Biomechanical consequences of a tear of the posterior root of the medial meniscus. Similar to total meniscectomy. J Bone Jt Surg Am 90(9):1922–1931CrossRefGoogle Scholar
  6. 6.
    Barber FA, Herbert MA, Coons DA, Boothby MH (2006) Sutures and suture anchors–update 2006. Arthroscopy 22(10):1063–1069PubMedCrossRefGoogle Scholar
  7. 7.
    Barber FA, Herbert MA, Richards DP (2003) Sutures and suture anchors: update 2003. Arthroscopy 19(9):985–990PubMedCrossRefGoogle Scholar
  8. 8.
    Barber FA, Herbert MA, Schroeder FA, Aziz-Jacobo J, Sutker MJ (2009) Biomechanical testing of new meniscal repair techniques containing ultra high-molecular weight polyethylene suture. Arthroscopy 25(9):959–967PubMedCrossRefGoogle Scholar
  9. 9.
    Bisson LJ, Manohar LM, Wilkins RD, Gurske-Deperio J, Ehrensberger MT (2008) Influence of suture material on the biomechanical behavior of suture-tendon specimens: a controlled study in bovine rotator cuff. Am J Sports Med 36(5):907–912PubMedCrossRefGoogle Scholar
  10. 10.
    Burgess R, Elder S, McLaughlin R, Constable P (2010) In vitro biomechanical evaluation and comparison of FiberWire, FiberTape, OrthoFiber, and nylon leader line for potential use during extraarticular stabilization of canine cruciate deficient stifles. Vet Surg 39(2):208–215PubMedCrossRefGoogle Scholar
  11. 11.
    Cho JH (2012) Modified pull-out suture in posterior root tear of the medial meniscus: using a posteromedial portal. Knee Surg Relat Res 24(2):124–127PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Choi SH, Bae S, Ji SK, Chang MJ (2012) The MRI findings of meniscal root tear of the medial meniscus: emphasis on coronal, sagittal and axial images. Knee Surg Sports Traumatol Arthrosc 20(10):2098–2103PubMedCrossRefGoogle Scholar
  13. 13.
    Deakin M, Stubbs D, Bruce W, Goldberg J, Gillies RM, Walsh WR (2005) Suture strength and angle of load application in a suture anchor eyelet. Arthroscopy 21(12):1447–1451PubMedCrossRefGoogle Scholar
  14. 14.
    Feucht MJ, Minzlaff P, Saier T, Lenich A, Imhoff AB, Hinterwimmer S (2013) Avulsion of the anterior medial meniscus root: case report and surgical technique. Knee Surg Sports Traumatol Arthrosc. doi: 10.1007/s00167-013-2462-7
  15. 15.
    Forkel P, Herbort M, Schulze M, Rosenbaum D, Kirstein L, Raschke M, Petersen W (2013) Biomechanical consequences of a posterior root tear of the lateral meniscus: stabilizing effect of the meniscofemoral ligament. Arch Orthop Trauma Surg 133(5):621–626PubMedCrossRefGoogle Scholar
  16. 16.
    Forkel P, Petersen W (2012) Posterior root tear fixation of the lateral meniscus combined with arthroscopic ACL double-bundle reconstruction: technical note of a transosseous fixation using the tibial PL tunnel. Arch Orthop Trauma Surg 132(3):387–391PubMedCrossRefGoogle Scholar
  17. 17.
    Han SB, Shetty GM, Lee DH, Chae DJ, Seo SS, Wang KH, Yoo SH, Nha KW (2010) Unfavorable results of partial meniscectomy for complete posterior medial meniscus root tear with early osteoarthritis: a 5- to 8-year follow-up study. Arthroscopy 26(10):1326–1332PubMedCrossRefGoogle Scholar
  18. 18.
    Harner CD, Mauro CS, Lesniak BP, Romanowski JR (2009) Biomechanical consequences of a tear of the posterior root of the medial meniscus. Surgical technique. J Bone Jt Surg Am 91(Suppl 2):257–270CrossRefGoogle Scholar
  19. 19.
    Hein CN, Deperio JG, Ehrensberger MT, Marzo JM (2011) Effects of medial meniscal posterior horn avulsion and repair on meniscal displacement. Knee 18(3):189–192PubMedCrossRefGoogle Scholar
  20. 20.
    Herbort M, Siam S, Lenschow S, Petersen W, Zantop T (2010) Strategies for repair of radial tears close to the meniscal rim–biomechanical analysis with a cyclic loading protocol. Am J Sports Med 38(11):2281–2287PubMedCrossRefGoogle Scholar
  21. 21.
    Jaspers P, de Lange A, Huiskes R, van Rens TJ (1980) The mechanical function of the meniscus, experiments on cadaveric pig knee-joints. Acta Orthop Belg 46(6):663–668PubMedGoogle Scholar
  22. 22.
    Johannsen AM, Civitarese DM, Padalecki JR, Goldsmith MT, Wijdicks CA, Laprade RF (2012) Qualitative and quantitative anatomic analysis of the posterior root attachments of the medial and lateral menisci. Am J Sports Med 40(10):2342–2347PubMedCrossRefGoogle Scholar
  23. 23.
    Kim JG, Lee YS, Bae TS, Ha JK, Lee DH, Kim YJ, Ra HJ (2012) Tibiofemoral contact mechanics following posterior root of medial meniscus tear, repair, meniscectomy, and allograft transplantation. Knee Surg Sports Traumatol Arthrosc. doi: 10.1007/s00167-012-2182-4
  24. 24.
    Kim JH, Chung JH, Lee DH, Lee YS, Kim JR, Ryu KJ (2011) Arthroscopic suture anchor repair versus pullout suture repair in posterior root tear of the medial meniscus: a prospective comparison study. Arthroscopy 27(12):1644–1653PubMedCrossRefGoogle Scholar
  25. 25.
    Kim SB, Ha JK, Lee SW, Kim DW, Shim JC, Kim JG, Lee MY (2011) Medial meniscus root tear refixation: comparison of clinical, radiologic, and arthroscopic findings with medial meniscectomy. Arthroscopy 27(3):346–354PubMedCrossRefGoogle Scholar
  26. 26.
    Kim YM, Joo YB (2013) Pullout failure strength of the posterior horn of the medial meniscus with root ligament tear. Knee Surg Sports Traumatol Arthrosc 21(7):1546–1552PubMedCrossRefGoogle Scholar
  27. 27.
    Kim YM, Rhee KJ, Lee JK, Hwang DS, Yang JY, Kim SJ (2006) Arthroscopic pullout repair of a complete radial tear of the tibial attachment site of the medial meniscus posterior horn. Arthroscopy 22(7):7951–7954Google Scholar
  28. 28.
    Koenig JH, Ranawat AS, Umans HR, Difelice GS (2009) Meniscal root tears: diagnosis and treatment. Arthroscopy 25(9):1025–1032PubMedCrossRefGoogle Scholar
  29. 29.
    Kohn D, Moreno B (1995) Meniscus insertion anatomy as a basis for meniscus replacement: a morphological cadaveric study. Arthroscopy 11(1):96–103PubMedCrossRefGoogle Scholar
  30. 30.
    Kopf S, Colvin AC, Muriuki M, Zhang X, Harner CD (2011) Meniscal root suturing techniques: implications for root fixation. Am J Sports Med 39(10):2141–2146PubMedCrossRefGoogle Scholar
  31. 31.
    Lawrence TM, Davis TR (2005) A biomechanical analysis of suture materials and their influence on a four-strand flexor tendon repair. J Hand Surg Am 30(4):836–841PubMedCrossRefGoogle Scholar
  32. 32.
    Lee DW, Jang SH, Ha JK, Kim JG, Ahn JH (2013) Meniscus root refixation technique using a modified Mason-Allen stitch. Knee Surg Sports Traumatol Arthrosc 21(3):654–657PubMedCrossRefGoogle Scholar
  33. 33.
    Lee JH, Lim YJ, Kim KB, Kim KH, Song JH (2009) Arthroscopic pullout suture repair of posterior root tear of the medial meniscus: radiographic and clinical results with a 2-year follow-up. Arthroscopy 25(9):951–958PubMedCrossRefGoogle Scholar
  34. 34.
    Lee YH, Nyland J, Burden R, Caborn DN (2012) Cyclic test comparison of all-inside device and inside-out sutures for radial meniscus lesion repair: an in vitro porcine model study. Arthroscopy 28(12):1873–1881PubMedCrossRefGoogle Scholar
  35. 35.
    Lee YH, Nyland J, Burden R, Caborn DN (2013) Repair of peripheral vertical meniscus lesions in porcine menisci: in vitro biomechanical testing of 3 different meniscus repair devices. Am J Sports Med 41(5):1873–1881CrossRefGoogle Scholar
  36. 36.
    Lo IK, Burkhart SS, Chan KC, Athanasiou K (2004) Arthroscopic knots: determining the optimal balance of loop security and knot security. Arthroscopy 20(5):489–502PubMedCrossRefGoogle Scholar
  37. 37.
    Marzo JM (2012) Meniscus root avulsion. Clin Sports Med 31(1):101–111PubMedCrossRefGoogle Scholar
  38. 38.
    Marzo JM, Gurske-DePerio J (2009) Effects of medial meniscus posterior horn avulsion and repair on tibiofemoral contact area and peak contact pressure with clinical implications. Am J Sports Med 37(1):124–129PubMedCrossRefGoogle Scholar
  39. 39.
    Messner K, Gao J (1998) The menisci of the knee joint. Anatomical and functional characteristics, and a rationale for clinical treatment. J Anat 193(Pt 2):161–178PubMedCentralPubMedCrossRefGoogle Scholar
  40. 40.
    Moon HK, Koh YG, Kim YC, Park YS, Jo SB, Kwon SK (2012) Prognostic factors of arthroscopic pull-out repair for a posterior root tear of the medial meniscus. Am J Sports Med 40(5):1138–1143PubMedCrossRefGoogle Scholar
  41. 41.
    Nakano T, Aherne FX (1992) Morphology and water and lipid contents of stifle menisci of growing swine. Can J Vet Res 56(2):165–167PubMedCentralPubMedGoogle Scholar
  42. 42.
    Nicholas SJ, Golant A, Schachter AK, Lee SJ (2009) A new surgical technique for arthroscopic repair of the meniscus root tear. Knee Surg Sports Traumatol Arthrosc 17(12):1433–1436PubMedCrossRefGoogle Scholar
  43. 43.
    Papalia R, Vasta S, Franceschi F, D’Adamio S, Maffulli N, Denaro V (2013) Meniscal root tears: from basic science to ultimate surgery. Br Med Bull. doi: 10.1093/bmb/ldt002
  44. 44.
    Park YS, Moon HK, Koh YG, Kim YC, Sim DS, Jo SB, Kwon SK (2011) Arthroscopic pullout repair of posterior root tear of the medial meniscus: the anterior approach using medial collateral ligament pie-crusting release. Knee Surg Sports Traumatol Arthrosc 19(8):1334–1336PubMedCrossRefGoogle Scholar
  45. 45.
    Petersen W, Tillmann B (1998) Collagenous fibril texture of the human knee joint menisci. Anat Embryol (Berl) 197(4):317–324CrossRefGoogle Scholar
  46. 46.
    Post WR, Akers SR, Kish V (1997) Load-to-failure of common meniscal repair techniques: effects of suture technique and suture material. Arthroscopy 13(6):731–736PubMedCrossRefGoogle Scholar
  47. 47.
    Robertson DD, Armfield DR, Towers JD, Irrgang JJ, Maloney WJ, Harner CD (2009) Meniscal root injury and spontaneous osteonecrosis of the knee: an observation. J Bone Jt Surg Br 91(2):190–195CrossRefGoogle Scholar
  48. 48.
    Rosslenbroich SB, Borgmann J, Herbort M, Raschke MJ, Petersen W, Zantop T (2013) Root tear of the meniscus: biomechanical evaluation of an arthroscopic refixation technique. Arch Orthop Trauma Surg 133(1):111–115PubMedCrossRefGoogle Scholar
  49. 49.
    Schillhammer CK, Werner FW, Scuderi MG, Cannizzaro JP (2012) Repair of lateral meniscus posterior horn detachment lesions: a biomechanical evaluation. Am J Sports Med 40(11):2604–2609PubMedCrossRefGoogle Scholar
  50. 50.
    Seo HS, Lee SC, Jung KA (2011) Second-look arthroscopic findings after repairs of posterior root tears of the medial meniscus. Am J Sports Med 39(1):99–107PubMedCrossRefGoogle Scholar
  51. 51.
    Starke C, Kopf S, Grobel KH, Becker R (2010) The effect of a nonanatomic repair of the meniscal horn attachment on meniscal tension: a biomechanical study. Arthroscopy 26(3):358–365PubMedCrossRefGoogle Scholar
  52. 52.
    Sung JH, Ha JK, Lee DW, Seo WY, Kim JG (2013) Meniscal extrusion and spontaneous osteonecrosis with root tear of medial meniscus: comparison with horizontal tear. Arthroscopy 29(4):726–732PubMedCrossRefGoogle Scholar
  53. 53.
    Vyas D, Harner CD (2012) Meniscus root repair. Sports Med Arthrosc 20(2):86–94PubMedCrossRefGoogle Scholar
  54. 54.
    Wright PB, Budoff JE, Yeh ML, Kelm ZS, Luo ZP (2006) Strength of damaged suture: an in vitro study. Arthroscopy 22(12):1270–1275PubMedCrossRefGoogle Scholar
  55. 55.
    Wust DM, Meyer DC, Favre P, Gerber C (2006) Mechanical and handling properties of braided polyblend polyethylene sutures in comparison to braided polyester and monofilament polydioxanone sutures. Arthroscopy 22(11):1146–1153PubMedCrossRefGoogle Scholar
  56. 56.
    Zantop T, Eggers AK, Musahl V, Weimann A, Petersen W (2005) Cyclic testing of flexible all-inside meniscus-suture anchors: biomechanical analysis. Am J Sports Med 33(3):388–394PubMedCrossRefGoogle Scholar
  57. 57.
    Zantop T, Eggers AK, Weimann A, Hassenpflug J, Petersen W (2004) Initial fixation strength of flexible all-inside meniscus-suture anchors in comparison to conventional suture technique and rigid anchors: biomechanical evaluation of new meniscus refixation systems. Am J Sports Med 32(4):863–869PubMedCrossRefGoogle Scholar
  58. 58.
    Zantop T, Temmig K, Weimann A, Eggers AK, Raschke MJ, Petersen W (2006) Elongation and structural properties of meniscal repair using suture techniques in distraction and shear force scenarios: biomechanical evaluation using a cyclic loading protocol. Am J Sports Med 34(5):799–805PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Matthias J. Feucht
    • 1
  • Eduardo Grande
    • 2
  • Johannes Brunhuber
    • 1
  • Nikolaus Rosenstiel
    • 1
  • Rainer Burgkart
    • 2
  • Andreas B. Imhoff
    • 1
    Email author
  • Sepp Braun
    • 1
  1. 1.Department of Orthopaedic Sports MedicineTechnical University MunichMunichGermany
  2. 2.Department of Orthopaedics, Biomechanic LabTechnical University MunichMunichGermany

Personalised recommendations