title: Cyclic displacement after meniscal root repair fixation: a human biomechanical evaluation.
abstract: BACKGROUND
  Recent biomechanical evidence suggests that the meniscus-suture interface contributes the most displacement to the transtibial pull-out repair for meniscal root tears. Therefore, optimization of surgical technique at the meniscus-suture interface may minimize displacement and improve the strength of meniscal root repairs.
  
  
  OBJECTIVE
  The purpose of this study was to investigate the cyclic displacement and ultimate failure loads of 4 different meniscus-suture fixation techniques for posterior medial meniscal root repairs in human meniscus tissue. The hypothesis was that there would be no significant difference between the two simple sutures (TSS) technique and 3 other techniques in cyclic displacement or ultimate failure load.
  
  
  METHODS
  Controlled laboratory study.
  
  
  METHODS
  A total of 32 fresh-frozen, human, medial meniscal transplant specimens were randomly assigned to 4 meniscus-suture fixation techniques used for transtibial pull-out repair in posterior medial meniscal root tears (n = 8 per group). The suture techniques studied were (1) TSS, (2) modified Mason-Allen (MMA), (3) single double-locking loop (S-DLL), and (4) double double-locking loop (D-DLL). The menisci were subjected to a cyclic tensioning protocol representative of postoperative rehabilitation (10-30 N for 1000 cycles) and pulled to failure at a rate of 0.5 mm/s.
  
  
  RESULTS
  After 1000 cycles, the TSS group displaced the least (mean ± SD, 1.78 ± 0.64 mm), followed by the MMA (2.14 ± 0.65 mm), D-DLL (2.97 ± 0.57 mm), and S-DLL (3.81 ± 0.78 mm) groups. After 100, 500, and 1000 cycles, suture displacements using the TSS and MMA techniques were not significantly different (P > .13), while the TSS technique resulted in significantly less displacement than the S-DLL and D-DLL (P < .03) techniques. The ultimate failure loads of the MMA (325 ± 77 N) and D-DLL (320 ± 50 N) techniques were significantly greater than those of the TSS (192 ± 52 N) and S-DLL (217 ± 51 N) techniques (P < .05).
  
  
  CONCLUSIONS
  The TSS and MMA fixation techniques were not significantly different, while the TSS was significantly better at resisting displacement when compared with the S-DLL and D-DLL stitch configurations. The MMA and D-DLL techniques exhibited significantly greater failure loads than did the TSS and S-DLL techniques; however, all techniques demonstrated ultimate failure loads above the currently accepted rehabilitation force threshold.
  
  
  CONCLUSIONS
  The TSS fixation technique combines the lowest technical difficulty and the ability to resist displacement at time zero. The MMA technique, although more technically challenging, may provide an alternative means to resist displacement while enhancing the failure load.
authors.affiliation: Steadman Philippon Research Institute, Vail, Colorado, USA The Steadman Clinic, Vail, Colorado, USA drlaprade@sprivail.org.
authors.forename: Robert F
authors.initials: RF
authors.lastname: LaPrade
authors.affiliation: Steadman Philippon Research Institute, Vail, Colorado, USA.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: LaPrade
authors.affiliation: Steadman Philippon Research Institute, Vail, Colorado, USA The Steadman Clinic, Vail, Colorado, USA.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Ellman
authors.affiliation: Steadman Philippon Research Institute, Vail, Colorado, USA.
authors.forename: Travis Lee
authors.initials: TL
authors.lastname: Turnbull
authors.affiliation: Steadman Philippon Research Institute, Vail, Colorado, USA The Steadman Clinic, Vail, Colorado, USA.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Cerminara
authors.affiliation: Steadman Philippon Research Institute, Vail, Colorado, USA.
authors.forename: Coen A
authors.initials: CA
authors.lastname: Wijdicks
mesh_terms: D000293:Adolescent; D000328:Adult; D001696:Biomechanical Phenomena; D002357:Cartilage Diseases / Q000601:surgery*; D002648:Child; D005260:Female; D006801:Humans; D066298:In Vitro Techniques; D007718:Knee Injuries / Q000601:surgery*; D008297:Male; D008592:Menisci, Tibial / Q000601:surgery*; D013536:Suture Techniques; D013537:Sutures; D055815:Young Adult
keywords: meniscal repair; meniscus root; pull-out repair; root tears; sutures