title: All-inside meniscal repair devices compared with their matched inside-out vertical mattress suture repair: introducing 10,000 and 100,000 loading cycles.
abstract: BACKGROUND
  All-inside arthroscopic meniscal repairs are favored by most clinicians because of their lower complication rate and decreased morbidity compared with inside-out techniques. Until now, only 1000 cycles have been used for biomechanical testing.
  
  
  OBJECTIVE
  All-inside meniscal repairs will show inferior biomechanical response to cyclic loading (up to 100,000 cycles) and load-to-failure testing compared with inside-out suture controls.
  
  
  METHODS
  Controlled laboratory study.
  
  
  METHODS
  Bucket-handle tears in 72 porcine menisci were repaired using the Omnispan and Fast-Fix 360 (all-inside devices) and Orthocord 2-0 and Ultrabraid 2-0 sutures (matched controls). Initial displacement, displacement after cyclic loading (100, 500, 1000, 2000, 5000, 10,000, and 100,000 cycles) between 5 and 20 N, ultimate load to failure, and mode of failure were recorded, as well as stiffness.
  
  
  RESULTS
  Initial displacement and displacement after cyclic loading were not different between the groups. The Omnispan repair demonstrated the highest load-to-failure force (mean ± SD, 151.3 ± 21.5 N) and was significantly stronger than all the other constructs (Orthocord 2-0, 105.5 ± 20.4 N; Ultrabraid 2-0, 93.4 ± 22.5 N; Fast-Fix 360, 76.6 ± 14.2 N) (P < .0001 for all). The Orthocord vertical inside-out mattress repair was significantly stronger than the Fast-Fix 360 repair (P = .003). The Omnispan (30.8 ± 3.5 N/mm) showed significantly higher stiffness compared with the Ultrabraid 2-0 (22.9 ± 6.9 N/mm, P < .0001) and Fast-Fix 360 (23.7 ± 3.9 N/mm, P = .001). The predominant mode of failure was suture failure.
  
  
  CONCLUSIONS
  All-inside meniscal devices show comparable biomechanical properties compared with inside-out suture repair in cyclic loading, even after 100,000 cycles.
  
  
  CONCLUSIONS
  Eight to 10 weeks of rehabilitation might not pose a problem for all repairs in this worst-case scenario.
authors: Orthopaedic Department, University Hospital Basel, University of Basel, Basel, Switzerland claudio.rosso@unibas.ch.
authors: Claudio
authors: C
authors: Rosso
authors: Department of Traumatology, University Hospital Basel, University of Basel, Basel, Switzerland.
authors: Sebastian
authors: S
authors: Müller
authors: Orthopaedic Department, University Hospital Basel, University of Basel, Basel, Switzerland Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors: Daniel M
authors: DM
authors: Buckland
authors: Orthopaedic Department, University Hospital Basel, University of Basel, Basel, Switzerland.
authors: Tanja
authors: T
authors: Schwenk
authors: School of Life Sciences, Institute for Medical and Analytical Technologies, University of Applied Sciences Northwestern Switzerland, Muttenz, Switzerland.
authors: Simon
authors: S
authors: Zimmermann
authors: School of Life Sciences, Institute for Medical and Analytical Technologies, University of Applied Sciences Northwestern Switzerland, Muttenz, Switzerland.
authors: Michael
authors: M
authors: de Wild
authors: Orthopaedic Department, University Hospital Basel, University of Basel, Basel, Switzerland.
authors: Victor
authors: V
authors: Valderrabano
mesh_terms: D000818:Animals; D001696:Biomechanical Phenomena; D008422:Materials Testing; D008592:Menisci, Tibial / Q000601:surgery*; D019637:Orthopedic Procedures / Q000295:instrumentation*; D011897:Random Allocation; D013314:Stress, Mechanical; D013536:Suture Techniques; D013552:Swine; D000070600:Tibial Meniscus Injuries
keywords: Fast-Fix 360; Omnispan; Orthocord; Ultrabraid; all-inside; biomechanical testing; biomechanics; meniscus; repair