Meta-analysis on biomechanical properties of meniscus repairs: are devices better than sutures?
OBJECTIVE
Meniscal repair devices have been extensively tested during the past decades as reported in the literature. Reviewing the different meniscal repair devices and sutures with their respective biomechanical properties.


METHODS
For this meta-analysis, we conducted a systematic online search using PubMed, EMBASE, CCTR, and CINAHL using the search terms Meniscus OR Meniscal AND Biomechanics AND Repair). Load-to-failure (LtF), stiffness, and cyclic outcome measures were extracted independently and in duplicate. The systematic search revealed 841 manuscripts in total. After exclusion of duplicates and irrelevant publications, 41 studies remained for final analysis. The studies were published in English and German from 1995 to 2013. Due to differing cyclic force protocols, cyclic outcomes had to be excluded.


RESULTS
Overall, sutures had a higher LtF [suture: 87.7 ± 0.3 N (weighted mean ± standard error), device: 56.3 ± 0.1 N] and stiffness (suture: 8.9 ± 0.04 N/mm, device: 8.6 ± 0.04 N/mm) than devices, both p < 0.05. In LfT testing, PDS 0 Vertical (145.0 ± 8.1 N), OrthoCord 2-0 (143.6 ± 11.3 N), and Ethibond No 0 Vertical (133.4 ± 7.7 N) were the strongest sutures and Meniscal Viper (140.9 ± 5.1 N), MaxFire Vertical (136.2 ± 11.3 N), and FasT-Fix Vertical (115.2 ± 1.6 N) were the strongest devices. Second-generation devices were significantly stronger and stiffer than first-generation devices (p < 0.001).


CONCLUSIONS
Suture repair remains the gold standard with a vertically oriented suture configuration showing superior LtF values compared to a horizontal configuration. Nevertheless, some meniscal repair devices have similar biomechanical properties to suture repairs. Both suture repairs and devices have a place in meniscal restoration.


METHODS
None, meta-analysis of controlled laboratory studies.
Orthopaedic Department, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
Daniel
D
M Buckland
Patrick
P
Sadoghi
Matthias D
MD
Wimmer
Patrick
P
Vavken
Geert I
GI
Pagenstert
Victor
V
Valderrabano
Claudio
C
Rosso
D020341:Absorbable Implants; D001696:Biomechanical Phenomena; D006801:Humans; D008592:Menisci, Tibial / Q000601:surgery*; D011093:Polyethylene Terephthalates; D013314:Stress, Mechanical; D013536:Suture Techniques / Q000295:instrumentation*; D013537:Sutures; D013718:Tensile Strength; D014945:Wound Healing
C014534:Ethibond; D011093:Polyethylene Terephthalates