title: What is the best way to fix a polyurethane meniscal scaffold? A biomechanical evaluation of different fixation modes.
abstract: OBJECTIVE
  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.
authors.affiliation: Knee and Sports Traumatology Unit, Orthopaedic Department, Leuven University Hospital, Weligerveld 1, 3212, Pellenberg, Belgium, francois.hardeman@gmail.com.
authors.forename: Francois
authors.initials: F
authors.lastname: Hardeman
authors.forename: Kristoff
authors.initials: K
authors.lastname: Corten
authors.forename: Michiel
authors.initials: M
authors.lastname: Mylle
authors.forename: Bert
authors.initials: B
authors.lastname: Van Herck
authors.forename: René
authors.initials: R
authors.lastname: Verdonk
authors.forename: Peter
authors.initials: P
authors.lastname: Verdonk
authors.forename: Johan
authors.initials: J
authors.lastname: Bellemans
mesh_terms: D000818:Animals; D001696:Biomechanical Phenomena; D008592:Menisci, Tibial / Q000601:surgery*; D011093:Polyethylene Terephthalates; D011140:Polyurethanes; D013536:Suture Techniques; D013537:Sutures; D013552:Swine; D013718:Tensile Strength; D054457:Tissue Scaffolds
chemical_list: C014534:Ethibond; D011093:Polyethylene Terephthalates; D011140:Polyurethanes