title: Repair of peripheral vertical meniscus lesions in porcine menisci: in vitro biomechanical testing of 3 different meniscus repair devices.
abstract: BACKGROUND
  All-inside meniscus repair eliminates the need for an extra incision and decreases neurovascular injury risk. Biomechanical testing can help delineate the efficacy of all-inside device use.
  
  
  OBJECTIVE
  There would be no group differences between 4 peripheral meniscus repair techniques and 3 different devices tested.
  
  
  METHODS
  Controlled laboratory study.
  
  
  METHODS
  Equivalent-sized menisci with attached tibiae were randomly assigned to 1 of 4 test groups (8 specimens each), as follows: group 1, Fast-Fix using No. 0 braided polyester suture; group 2, inside-out repair using 2-0 braided polyester suture; group 3, Sequent using No. 0 ultra-high molecular weight polyethylene (UHMWPE) suture in a continuous "N" configuration; and group 4, Sequent using No. 0 UHMWPE suture in an interrupted configuration. After placement in a clamp, specimens underwent preconditioning from 5 to 20 N for 10 cycles (0.1 Hz), 500 submaximal loading cycles from 5 to 20 N (0.5 Hz), and load-to-failure testing at 12.5 mm/s. A 30-second pause after 10 preconditioning cycles and after 10, 100, and 500 submaximal loading cycles enabled digital photographs to be taken for gapping measurements. Failure mode was recorded.
  
  
  RESULTS
  Specimens in group 3 withstood greater failure loads than did those in groups 1 and 4 (P ≤ .027), and group 3 specimens were stiffer than those in groups 2 and 4 (P ≤ .048). Displacement during submaximal loading and load-to-failure testing did not differ between groups. Groups 1, 3, and 4 each gapped less than group 2 during submaximal cyclic loading (P ≤ .05). Groups 1 and 2 failed primarily by suture breakage (P < .0001), while groups 3 and 4 failed primarily by the suture pulling free from an implant (P < .0001).
  
  
  CONCLUSIONS
  Sequent using No. 0 UHMWPE suture in a continuous "N" configuration displayed superior load at failure compared with repairs using Fast-Fix with No. 0 braided polyester suture and displayed greater stiffness and less gapping than inside-out repair using 2-0 braided polyester suture. The suture pulling free from an implant was the primary failure mode for Sequent using No. 0 UHMWPE suture regardless of whether a continuous "N" or an interrupted configuration was used. Study groups that used No. 0 UHMWPE sutures (groups 3 and 4) had more specimens fail by the suture pulling free from an implant. Compared with the weaker braided polyester suture in the inside-out and Fast-Fix groups, the No. 0 UHMWPE suture used in the Sequent groups likely influenced study results, as this suture has stronger material properties. However, the continuous "N" configuration likely also improved the performance of the Sequent with No. 0 UHMWPE suture, as failure load was significantly less with an interrupted configuration.
  
  
  CONCLUSIONS
  All-inside meniscus repair with continuous suture function may translate into improved patient outcomes.
authors.affiliation: Division of Sports Medicine, Department of Orthopaedic Surgery, University of Louisville, Louisville, KY 40202, USA.
authors.forename: Yee Han Dave
authors.initials: YH
authors.lastname: Lee
authors.forename: John
authors.initials: J
authors.lastname: Nyland
authors.forename: Robert
authors.initials: R
authors.lastname: Burden
authors.forename: David N M
authors.initials: DN
authors.lastname: Caborn
mesh_terms: D000704:Analysis of Variance; D000818:Animals; D001696:Biomechanical Phenomena; D008592:Menisci, Tibial / Q000503:physiopathology / Q000601:surgery*; D019637:Orthopedic Procedures / Q000295:instrumentation / Q000379:methods*; D011897:Random Allocation; D012421:Rupture / Q000209:etiology; D013314:Stress, Mechanical; D013536:Suture Techniques; D013537:Sutures; D013552:Swine; D013718:Tensile Strength; D013977:Tibia; D000070600:Tibial Meniscus Injuries
keywords: biomechanical testing; implant; in vitro; meniscus repair