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A new rigid biodegradable anchor for meniscus refixation: biomechanical evaluation

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

Abstract

All-inside repair devices have been developed to overcome the disadvantages of conventional suture techniques (such as vein and nerve damage and increased OR time). The Contour Meniscus Arrow is a second generation of the first biodegradable all-inside implant, the Meniscus Arrow. The aim of this study was to compare the biomechanical properties of the Contour Meniscus Arrow to the first-generation Meniscus Arrow and vertical or horizontal suture techniques. In fresh frozen bovine menisci, initial fixation strength, stiffness and failure mode of four different meniscus refixation techniques (Meniscus Arrow, Contour Meniscus Arrow, vertical and horizontal 2–0 Ethibond suture techniques) were evaluated in a computer-based material-testing machine at a rate of 12.5 mm/s. Vertical meniscus sutures showed the highest initial fixation strength, followed by the horizontal suture technique and the Contour Arrow. The Meniscus Arrow showed inferior pull-out strength. Subjecting the different refixation techniques to cyclic testing decreased the fixation strength in all groups. The modified Meniscus Anchor (Contour Arrow) provides biomechanical properties that are superior (pull-out strength) or similar (stiffness) compared to the first biodegradable all-inside implant, the Meniscus Arrow. The pull-out strength of the Contour Arrow was comparable to the pull-out strength reported for horizontal meniscus sutures in the literature. These biomechanical characteristics of this new implant justify clinical use.

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References

  1. Albrecht-Olsen P, Kristensen G, Tormälä P (1993) Meniscus bucket-handle fixation with an absorbable Biofix tack: development of a new technique. Knee Surg Sports Traumatol Arthroscopy 1:104–106

    Google Scholar 

  2. Albrecht-Olsen P, Lind T, Kristensen G (1997) Failure strength of a new Meniscus Arrow repair technique: biomechanical comparison with horizontal suture. Arthroscopy 13:183–187

    CAS  PubMed  Google Scholar 

  3. Albrecht-Olsen P, Kristensen G, Burgaard P (1999) The arrow versus horizontal suture in arthroscopic meniscus repair: a prospective randomized study with arthroscopic evaluation. Knee Surg Sports Traumatol Arthrosc 7:268–273

    CAS  PubMed  Google Scholar 

  4. Anderson K, Marx RG, Hannafin J (2000) Chondral injury following meniscal repair with biodegradable implant. Arthroscopy 16:749–753

    CAS  PubMed  Google Scholar 

  5. Arnoczky SP, Warren RF, Spivak JM (1988) Meniscal repair using an exogenous fibrin clot. An experimental study in dogs. J Bone Joint Surg 70:1209–1217

    CAS  PubMed  Google Scholar 

  6. Arnoczky SP, Lavagnino M (2001) Tensile fixation strength of absorbable meniscal repair devices as a function of hydrolysis time. Am J Sports Med 29:118–123

    CAS  PubMed  Google Scholar 

  7. Asik M, Sener N (2002) Failure strength of repair devices versus meniscus suturing techniques. Knee Surg Sports Traumatol Arthrosc 10:25–29

    PubMed  Google Scholar 

  8. Barber FA (1994) Accelerated rehabilitation for meniscus repairs. Arthroscopy 10:206–210

    CAS  PubMed  Google Scholar 

  9. Barber FA, Herbert MA (2000) Meniscal repair devices. Arthroscopy 16:613–618

    CAS  PubMed  Google Scholar 

  10. Becker R, Schoeder M, Stärke C (2001) Biomechanical investigations of different meniscal repair implants in comparison with horizontal sutures on human meniscus. Arthroscopy 17:439–444

    CAS  PubMed  Google Scholar 

  11. Becker R, Stärke C, Heymann M (2002) Biomechanical properties under cyclic loading of seven meniscus repair techniques. Clin Orthop 400:236–245

    PubMed  Google Scholar 

  12. Bellemans J, Vandenneucker H, Labey L, Van Audekercke R (2002) Fixation strength of meniscal repair devices. Knee 9:11–14

    Article  CAS  PubMed  Google Scholar 

  13. Boenisch UW, Faber KJ Ciarelli M, Steadman JR, Arnoczky SP (1999) Pull-out strength and stiffness of meniscal repair using absorbable arrows or Ti-Cron vertical and horizontal loop sutures. Am J Sports Med 27:626–631

    CAS  PubMed  Google Scholar 

  14. Bullough PG, Munuera L, Murphy J (1979) The strength of the menisci of the knee as it relates to their fine structure. J Bone Joint Surg Br 52:564–570

    Google Scholar 

  15. Dervin GF, Downing KJ, Keene GC, McBride DG (1997) Failure strengths of suture versus biodegradable arrow for meniscal repair: an in vitro study. Arthroscopy 13:296–300

    CAS  PubMed  Google Scholar 

  16. Durselen L, Schneider J, Galler M, Claes LE, Bauer G (2003) Cyclic joint loading can affect the initial stability of meniscal fixation implants. Clin Biomech 18:44–49

    Article  Google Scholar 

  17. Ellermann, Siebold R, Buelow JU (2002) Clinical evaluation of meniscus repair with a bioabsorbable arrow: a 2- to 3-year follow-up study. Knee Surg Sports Traumatol Arthrosc 10:289–293

    Google Scholar 

  18. Eriksson E (2003) Meniscus repair. Knee Surg Sports Traumatol Arthrosc 11:1

    Google Scholar 

  19. Fisher ST, Marken DC, Koman JD (2002) Pull-out and shear failure strength of arthroscopic meniscal repair systems. Knee Surg Sports Traumatol Arthrosc 10:294–299

    PubMed  Google Scholar 

  20. Kirsch L, Kohn D, Glowik A (1999) Forces in medial and lateral meniscus sutures during knee extension – an in vitro study. J Biomech 31:104

    Article  Google Scholar 

  21. Kohn DM, Siebert W (1989) Meniscus suture techniques: a comparative biomechanical cadaver study. Arthroscopy 5:324–327

    CAS  PubMed  Google Scholar 

  22. Koukoubis TD, Glisson RR, Feagin JA (1997) Meniscal fixation with an absorbable staple. An experimental study in dogs. Knee Surg Sports Traumatol Arthrosc 5:22–30

    Google Scholar 

  23. Laprell H, Stein V, Petersen W (2002) Arthroscopic all-inside meniscus repair using a new refixation device: a prospective study. Arthroscopy 18:387–393

    Article  PubMed  Google Scholar 

  24. McDermott ID, Richards SW, Hallam P (2002) A biomechanical study of four different meniscal repair systems, comparing pull-out strength and gapping under cyclic loading. Knee Surg Sports Traumatol Arthrosc 10:294–299

    PubMed  Google Scholar 

  25. Nagarkatti DG, McKeon BP, Donahue BS (2001) Mechanical evaluation of a soft tissue interference screw in free tendon anterior cruciate ligament graft fixation. Am J Sports Med 29:67–71

    CAS  PubMed  Google Scholar 

  26. Pauwels F (1960) Eine neue Theorie über den Einfluß mechanischer Reize auf die Differenzierung der Stützgewebe. Zehnter Beitrag zur funktionellen Anatomie und kausalen Morphologie des Stützapparates. Z Anat Entwicklungsgesch 121:478–515

    CAS  Google Scholar 

  27. Petersen W, Tillmann B (1998) Collagenous fibril texture of the human knee joint menisci. Anat Embryol (Berl) 197:317–324

    Google Scholar 

  28. Petersen W, Tillmann B (1999) [Structure and vascularization of the knee joint menisci]. Z Orthop Ihre Grenzgeb 137:31

    CAS  PubMed  Google Scholar 

  29. Post WR, Akers SR, Kish V (1997) Load to failure of common meniscal repair techniques and suture material. Arthroscopy 13:731–736

    CAS  PubMed  Google Scholar 

  30. Proctor CS, Schmidt MB, Whipple RR (1989) Material properties of the normal medial bovine meniscus. J Orthop Res 7:771–782

    CAS  PubMed  Google Scholar 

  31. Rankin CC, Lintner DM, Noble PC (2002) A biomechanical analysis of meniscal repair techniques. Am J Sports Med 30:492–497

    PubMed  Google Scholar 

  32. Rimmer MG, Nawana NS, Keene GCR (1995) Failure strength of different meniscal suturing techniques. Arthroscopy 11:146–150

    CAS  PubMed  Google Scholar 

  33. Ross G, Grabhill J, McDevitt (2000) Chondral injury after meniscal repair with bioabsorbable arrows. Arthroscopy 16:754–756

    CAS  PubMed  Google Scholar 

  34. Seil R, Rupp S, Dienst M, Müller B (2000) Chondral lesion after arthroscopic meniscus repair using Meniscus Arrows. Arthroscopy 16:E17

    CAS  PubMed  Google Scholar 

  35. Seil R, Rupp S, Kohn D (2000) Cyclic testing of meniscal sutures. Arthoscopy 16:505–510

    Article  CAS  Google Scholar 

  36. Seil R, Rupp S Jurecka C, Rein R (2001) [Effect of suture strength factors on behavior of meniscus sutures in cyclic loading conditions] Unfallchirurg 104:392–398

    Google Scholar 

  37. Song EK, Lee KB (1999) Biomechanical test comparing the load to failure of the biodegradable arrow versus meniscal suture. Arthroscopy 15:726–732

    CAS  PubMed  Google Scholar 

  38. Törmälä P, Karhi O, Koho P, Tamminmäki M (2000) A novel inserter instrument (Crossbow) for installation of self-reinforced bioabsorbable arrows into meniscus tissue. Knee Surg Sports Traumatol Arthrosc 8:370–372

    Google Scholar 

  39. Walsh SP, Evans SL, O’Doherty DM, Barlow IW (2001) Failure strengths of suture vs. biodegradable arrow and staple for meniscal repair: an in vitro study. Knee 8:151–156

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

We would like to thank Mr. S. Zander and Mr. A. Studt for their expert technical assistance. The implants used in this study were kindly provided by BIONX Implants, Tampere, Finland. None of the authors received financial support of any commercial party

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Christian-Albrechts-University Kiel, Michaelisstrasse 1, 24105 , Kiel, Germany

    Thore Zantop, Anne Kathleen Eggers, Andre Weimann & Joachim Hassenpflug

  2. Department of Orthopedic Surgery, University of Pittsburgh, Suite 1011, Kaufmann Building, 3471 Fifth Avenue, Pittsburgh, PA 15261, USA

    Volker Musahl

  3. Department of Trauma, Hand and Reconstructive Surgery, Westfälische Wilhelms-University Münster, Waldeyerstrasse 1, 48149 , Münster, Germany

    Wolf Petersen

Authors
  1. Thore Zantop
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  2. Anne Kathleen Eggers
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  3. Volker Musahl
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  4. Andre Weimann
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  5. Joachim Hassenpflug
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  6. Wolf Petersen
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Correspondence to Wolf Petersen.

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Zantop, T., Eggers, A.K., Musahl, V. et al. A new rigid biodegradable anchor for meniscus refixation: biomechanical evaluation. Knee Surg Sports Traumatol Arthrosc 12, 317–324 (2004). https://doi.org/10.1007/s00167-003-0439-7

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  • DOI: https://doi.org/10.1007/s00167-003-0439-7

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