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What is the best way to fix a polyurethane meniscal scaffold? A biomechanical evaluation of different fixation modes

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

Abstract

Purpose

Ingrowth of meniscal tissue into a meniscal scaffold can be optimized by securely fixing the scaffold into the meniscal remnants. The purpose of this research was to test and compare commonly used suture types and suture materials to fix a meniscal scaffold.

Methods

Forty fresh porcine menisci were used. All tests used the same polyurethane-based scaffold. The load to failure of horizontal, vertical and diagonal sutures with PDS 0 and with Ethibond 0, and diagonal sutures with Ultra Fast-Fix® and Sequent® to fix a meniscal scaffold were tested. Five tests were conducted for each configuration.

Results

All constructs failed in the scaffold at a mean pullout force of 50.6 N (SD 12.7). Inferior results were noted for vertical sutures (40.1 N, SD 6.3) compared to horizontal (49.8 N, SD 5.5, p = 0.0007) and diagonal (51.7 N, SD 15.6, p = 0.024) sutures and for Ethibond 0 (41.4 N, SD 6.2) compared to PDS 0 (51.3 N, SD 12.9, p = 0.001). When comparing the diagonal suture placements, only Ethibond 0 (42.9 N, SD 5.4) showed significantly inferior results compared to PDS 0 (60.1 N, SD 16.9, p = 0.03), Ultra Fast-Fix® (60.1 N, SD 9.3, p = 0.004) and Sequent® (65.8 N, SD 4.4, p < 0.0001).

Conclusions

The most common failure mode when fixing a polyurethane-based meniscal scaffold is suture pull-through of the scaffold in the distraction mode. This happens at a rather low pullout force and might preclude the use of this scaffold clinically. Vertical sutures and Ethibond 0 multifilament braided sutures fail at lower forces, and the tested commercial devices show promising results.

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References

  1. Agrawal CM, Ray RB (2001) Biodegradable polymeric scaffolds for musculoskeletal tissue engineering. J Biomed Mater Res 55:141–150

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  3. Allen PR, Denham RA, Swan AV (1984) Late degenerative changes after meniscectomy. J Bone Joint Surg Br 66:666–671

    CAS  PubMed  Google Scholar 

  4. Arnoczky SP (1999) Building a meniscus. Biologic considerations. Clin Orthop Relat Res 367:S244–S253

    Article  PubMed  Google Scholar 

  5. Aros BC, Pedroza A, Vasileff WK, Litsky AS, Flanigan DC (2010) Mechanical comparison of meniscal repair devices with mattress suture devices in vitro. Knee Surg Sports Traumatol Arthrosc 18:1594–1598

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  7. 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  CAS  PubMed  Google Scholar 

  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 25:959–967

    Article  PubMed  Google Scholar 

  9. Becker R, Brettschneider O, Grobel KH, von Versen R, Starke C (2006) Distraction forces on repaired bucket-handle lesions in the medial meniscus. Am J Sports Med 34:1941–1947

    Article  PubMed  Google Scholar 

  10. Brucker PU, Favre P, Puskas G, 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 

  11. Buma P, Ramrattan NN, van Tienen TG, Veth RP (2004) Tissue engineering of the meniscus. Biomaterials 25:1523–1532

    Article  CAS  PubMed  Google Scholar 

  12. Chang HC, Nyland J, Caborn DN, Burden R (2005) Biomechanical evaluation of meniscal repair systems: a comparison of the meniscal viper repair system, the vertical mattress FasT-fix device, and vertical mattress ethibond sutures. Am J Sports Med 33:1846–1852

    Article  PubMed  Google Scholar 

  13. Chang JH, Shen HC, Huang GS, Pan RY, Wu CF, Lee CH, Chen Q (2009) A biomechanical comparison of all-inside meniscus repair techniques. J Surg Res 155:82–88

    Article  PubMed Central  PubMed  Google Scholar 

  14. Cole BJ, Dennis MG, Lee SJ, Nho SJ, Kalsi RS, Hayden JK, Verma NN (2006) Prospective evaluation of allograft meniscus transplantation: a minimum 2-year follow-up. Am J Sports Med 34:919–927

    Article  PubMed  Google Scholar 

  15. De Coninck T, Huysse W, Willemot L, Verdonk R, Verstraete K, Verdonk P (2013) Two-year follow-up study on clinical and radiological outcomes of polyurethane meniscal scaffolds. Am J Sports Med 41:64–72

    Article  PubMed  Google Scholar 

  16. Efe T, Getgood A, Schofer MD, Fuchs-Winkelmann S, Mann D, Paletta JR, Heyse TJ (2012) The safety and short-term efficacy of a novel polyurethane meniscal scaffold for the treatment of segmental medial meniscal deficiency. Knee Surg Sports Traumatol Arthrosc 20:1822–1830

    Article  PubMed  Google Scholar 

  17. Fetzer GB, Spindler KP, Amendola A, Andrish JT, Bergfeld JA, Dunn WR, Flanigan DC, Jones M, Kaeding CC, Marx RG, Matava MJ, McCarty EC, Parker RD, Wolcott M, Vidal A, Wolf BR, Wright RW (2009) Potential market for new meniscus repair strategies: evaluation of the MOON cohort. J Knee Surg 22:180–186

    Article  PubMed Central  PubMed  Google Scholar 

  18. Galley NK, Gleghorn JP, Rodeo S, Warren RF, Maher SA, Bonassar LJ (2011) Frictional properties of the meniscus improve after scaffold-augmented repair of partial meniscectomy: a pilot study. Clin Orthop Relat Res 469:2817–2823

    Article  PubMed Central  PubMed  Google Scholar 

  19. Gunes T, Bostan B, Erdem M, Asci M, Sen C, Kelestemur MH (2009) Biomechanical evaluation of arthroscopic all-inside meniscus repairs. Knee Surg Sports Traumatol Arthrosc 17:1347–1353

    Article  PubMed  Google Scholar 

  20. Habata T, Uematsu K, Hattori K, Takakura Y, Fujisawa Y (2004) Clinical features of the posterior horn tear in the medial meniscus. Arch Orthop Trauma Surg 124:642–645

    Article  CAS  PubMed  Google Scholar 

  21. Hennerbichler A, Moutos FT, Hennerbichler D, Weinberg JB, Guilak F (2007) Repair response of the inner and outer regions of the porcine meniscus in vitro. Am J Sports Med 35:754–762

    Article  PubMed  Google Scholar 

  22. Hommen JP, Applegate GR, Del Pizzo W (2007) Meniscus allograft transplantation: ten-year results of cryopreserved allografts. Arthroscopy 23:388–393

    Article  PubMed  Google Scholar 

  23. Kocabey Y, Chang HC, Brand JC, Nawab A, Nyland J, Caborn DNM (2006) A biomechanical comparison of the FasT-fix meniscal repair suture system and the Rapid Loc device in cadaver meniscus. Arthroscopy 22:406–413

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  25. McDermott ID, Amis AA (2006) The consequences of meniscectomy. J Bone Joint Surg [Br] 88:1549–1556

    Article  CAS  Google Scholar 

  26. Monllau JC, Gelber PE, Abat F, Pelfort X, Abad R, Hinarejos P, Tey M (2011) Outcome after partial medial meniscus substitution with the collagen meniscal implant at a minimum of 10 years’ follow-up. Arthroscopy 27:933–943

    Article  PubMed  Google Scholar 

  27. Naqui SZ, Thiryayi WA, Hopgood P, Ryan WG (2006) A biomechanical comparison of the mitek RapidLoc, mitek meniscal repair system, clearfix screws and vertical PDS and Ti-Cron sutures. Knee 13:151–157

    Article  CAS  PubMed  Google Scholar 

  28. Pereira H, Frias AM, Oliveira JM, Espregueira-Mendes J, Reis RL (2011) Tissue engineering and regenerative medicine strategies in meniscus lesions. Arthroscopy 27:1706–1719

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  30. Rodkey WG, DeHaven KE, Montgomery WH, Baker CL, Beck CL, Hormel SE, Steadman JR, Cole BJ, Briggs KK (2008) Comparison of the collagen meniscus implant with partial meniscectomy. A prospective randomized trial. J Bone Joint Surg [Am] 90:1414–1426

    Article  Google Scholar 

  31. Seo JH, Li G, Shetty GM, Kim JH, Bae JH, Jo ML, Kim JS, Lee SJ, Nha KW (2009) Effect of repair of radial tears at the root of the posterior horn of the medial meniscus with the pullout suture technique: a biomechanical study using porcine knees. Arthroscopy 25:1281–1287

    Article  PubMed  Google Scholar 

  32. Spencer SJ, Saithna A, Carmont MR, Dhillon MS, Thompson P, Spalding T (2012) Meniscal scaffolds: early experience and review of the literature. Knee 19:760–765

    Article  CAS  PubMed  Google Scholar 

  33. Stärke C, Kopf S, Petersen W, Becker R (2009) Meniscal repair. Arthroscopy 25:1033–1044

    Article  PubMed  Google Scholar 

  34. Steadman JR, Rodkey WG (2005) Tissue-engineered collagen meniscus implants: 5- to 6-year feasibility study results. Arthroscopy 21:515–525

    Article  PubMed  Google Scholar 

  35. van Tienen TG, Hannink G, Buma P (2009) Meniscus replacement using synthetic materials. Clin Sports Med 28:143–156

    Article  PubMed  Google Scholar 

  36. van Tienen TG, Heijkants RG, de Groot JH, Pennings AJ, Schouten AJ, Veth RP, Buma P (2006) Replacement of the knee meniscus by a polymer implant: a study in dogs. Am J Sports Med 34:64–71

    Article  PubMed  Google Scholar 

  37. Verdonk P, Beaufils P, Bellemans J, Djian P, Heinrichs EL, Huysse W, Laprell H, Siebold R, Verdonk R, Actifit Study Group (2012) Successful treatment of painful irreparable partial meniscal defects with a polyurethane scaffold: two-year safety and clinical outcomes. Am J Sports Med 40:844–853

    Article  PubMed  Google Scholar 

  38. Verdonk P, Demurie A, Almqvist KF, Veys EM, Verbruggen G, Verdonk R (2005) Transplantation of viable meniscal allograft. Survivorship analysis and clinical outcome of one hundred cases. J Bone Joint Surg [Am] 87:715–724

    Article  Google Scholar 

  39. Verdonk R, Verdonk P, Huysse W, Forsyth R, Heinrichs E (2011) Tissue ingrowth after implantation of a novel, biodegradable polyurethane scaffold for treatment of partial meniscal lesions. Am J Sports Med 39:774–782

    Article  PubMed  Google Scholar 

  40. Weinand C, Peretti GM, Adams SB Jr, Bonassar LJ, Randolph MA, Gill TJ (2006) An allogenic cell-based implant for meniscal lesions. Am J Sports Med 34:1779–1789

    Article  PubMed  Google Scholar 

  41. Welsing RT, van Tienen TG, Ramrattan N, Heijkants R, Schouten AJ, Veth RP, Buma P (2008) Effect on tissue differentiation and articular cartilage degradation of a polymer meniscus implant: a 2-year follow-up study in dogs. Am J Sports Med 36:1978–1989

    Article  PubMed  Google Scholar 

  42. 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 33:388–394

    Article  PubMed  Google Scholar 

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Acknowledgments

All implant materials that have been used in this study were provided by the industry: The aliphatic polyurethane-based scaffold was provided by Actifit Medical Meniscal Implant®, Orteq Ltd., London, UK, the meniscal suturing devices Ultra Fast-Fix® by Smith & Nephew Endoscopy, Andover, Massachusetts and Sequent® by Linvatec Corporation, Largo, Florida.

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Authors and Affiliations

  1. Knee and Sports Traumatology Unit, Orthopaedic Department, Leuven University Hospital, Weligerveld 1, 3212, Pellenberg, Belgium

    Francois Hardeman, Kristoff Corten, Michiel Mylle, Bert Van Herck & Johan Bellemans

  2. Orthopaedic Department, Ghent University Hospital, Ghent, Belgium

    René Verdonk & Peter Verdonk

Authors
  1. Francois Hardeman
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  2. Kristoff Corten
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  3. Michiel Mylle
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  7. Johan Bellemans
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Correspondence to Francois Hardeman.

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Hardeman, F., Corten, K., Mylle, M. et al. What is the best way to fix a polyurethane meniscal scaffold? A biomechanical evaluation of different fixation modes. Knee Surg Sports Traumatol Arthrosc 23, 59–64 (2015). https://doi.org/10.1007/s00167-013-2495-y

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