title: Analysis of a new all-inside versus inside-out technique for repairing radial meniscal tears.
abstract: OBJECTIVE
  The purpose of this study was to compare gap formation, strength, and stiffness of repaired radial tears of the meniscus treated using a new all-inside technique versus a traditional inside-out suture technique.
  
  
  METHODS
  Radial tears were created in 36 fresh-frozen porcine menisci. Repairs were performed using a novel all-inside suture-based meniscal repair device or an inside-out technique. The repairs were tested for cyclic loading and load to failure. The displacement, response to cyclic loading (100, 300, and 500 cycles), and mode of failure were recorded, and the construct's stiffness was calculated.
  
  
  RESULTS
  The all-inside repairs using the novel device resulted in a significantly lower displacement (gap formation) after 100, 300, and 500 cycles (P = .002, P = .001, and P = .001, respectively). The ultimate load to failure was significantly greater for the all-inside repairs (111.61 N v 95.01 N; P = .03). The all-inside repairs showed greater stiffness (14.53 N/mm v 11.19 N/mm; P = .02). The all-inside repairs failed most often by suture breakage (suture failure). The inside-out repairs failed most commonly when the suture pulled through the tissue (tissue failure) (P < .001).
  
  
  CONCLUSIONS
  For repair of radial tears of the meniscus, the vertical suture configuration created by the all-inside technique resulted in lower displacement, higher load to failure, and greater stiffness compared with the horizontal inside-out technique.
  
  
  CONCLUSIONS
  In a porcine specimen meniscus repair model, the biomechanical properties of a vertical all-inside technique were superior to that of a horizontal inside-out technique. Future studies of biomechanical and clinical outcomes in human meniscal repairs with this device are warranted to explore whether this repair method is valuable to clinical practice and patient outcomes.
authors.affiliation: Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A.
authors.forename: Brandon S
authors.initials: BS
authors.lastname: Beamer
authors.affiliation: Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A.
authors.forename: Aidin
authors.initials: A
authors.lastname: Masoudi
authors.affiliation: Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A.
authors.forename: Kempland C
authors.initials: KC
authors.lastname: Walley
authors.affiliation: Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A.
authors.forename: Ethan R
authors.initials: ER
authors.lastname: Harlow
authors.affiliation: Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A.
authors.forename: Ohan S
authors.initials: OS
authors.lastname: Manoukian
authors.affiliation: Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A.
authors.forename: Ben
authors.initials: B
authors.lastname: Hertz
authors.affiliation: Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A.
authors.forename: Claudia
authors.initials: C
authors.lastname: Haeussler
authors.affiliation: Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Olson
authors.affiliation: Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A.
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Deangelis
authors.affiliation: Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A.. Electronic address: aramappa@bidmc.harvard.edu.
authors.forename: Ara
authors.initials: A
authors.lastname: Nazarian
authors.affiliation: Center for Advanced Orthopaedic Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A.
authors.forename: Arun J
authors.initials: AJ
authors.lastname: Ramappa
mesh_terms: D000818:Animals; D001696:Biomechanical Phenomena; D004195:Disease Models, Animal; D007718:Knee Injuries / Q000503:physiopathology / Q000601:surgery*; D008592:Menisci, Tibial / Q000503:physiopathology / Q000601:surgery*; D013536:Suture Techniques; D013552:Swine; D000070600:Tibial Meniscus Injuries; D014945:Wound Healing