title: A Novel Repair Method for Radial Tears of the Medial Meniscus: Biomechanical Comparison of Transtibial 2-Tunnel and Double Horizontal Mattress Suture Techniques Under Cyclic Loading.
abstract: BACKGROUND
  Complete radial tears of the medial meniscus have been reported to be functionally similar to a total meniscectomy. At present, there is no consensus on an ideal technique for repair of radial midbody tears of the medial meniscus. Prior attempts at repair with double horizontal mattress suture techniques have led to a reportedly high rate of incomplete healing or healing in a nonanatomic (gapped) position, which compromises the ability of the meniscus to withstand hoop stresses.
  
  
  OBJECTIVE
  A newly proposed 2-tunnel radial meniscal repair method will result in decreased gapping and increased ultimate failure loads compared with the double horizontal mattress suture repair technique under cyclic loading.
  
  
  METHODS
  Controlled laboratory study.
  
  
  METHODS
  Ten matched pairs of male human cadaveric knees (average age, 58.6 years; range, 48-66 years) were used. A complete radial medial meniscal tear was made at the junction of the posterior one-third and middle third of the meniscus. One knee underwent a horizontal mattress inside-out repair, while the contralateral knee underwent a radial meniscal repair entailing the same technique with a concurrent novel 2-tunnel repair. Specimens were potted and mounted on a universal testing machine. Each specimen was cyclically loaded 1000 times with loads between 5 and 20 N before experiencing a load to failure. Gap distances at the tear site and failure load were measured.
  
  
  RESULTS
  The 2-tunnel repairs exhibited a significantly stronger ultimate failure load (median, 196 N; range, 163-212 N) than did the double horizontal mattress suture repairs (median, 106 N; range, 63-229 N) (P = .004). In addition, the 2-tunnel repairs demonstrated decreased gapping at all testing states (P < .05) with a final measured gapping of 1.7 mm and 4.1 mm after 1000 cycles for the 2-tunnel and double horizontal mattress suture repairs, respectively.
  
  
  CONCLUSIONS
  The 2-tunnel repairs displayed significantly less gapping distance after cyclic loading and had significantly stronger ultimate failure loads compared with the double horizontal mattress suture repairs.
  
  
  CONCLUSIONS
  Complete radial tears of the medial meniscus significantly decrease the ability of the meniscus to dissipate tibiofemoral loads, predisposing patients to early osteoarthritis. Improving the ability to repair medial meniscal radial tears in a way that withstands cyclic loads and heals in an anatomic position could significantly improve patient healing rates and result in improved preservation of the articular cartilage of the medial compartment of the knee. The 2-tunnel repair may be a more reliable and stronger repair option for midbody radial tears of the medial meniscus. Clinical studies are warranted to further evaluate these repairs.
authors.affiliation: Steadman Philippon Research Institute, Vail, Colorado, USA The Steadman Clinic, Vail, Colorado, USA.
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Bhatia
authors.affiliation: Steadman Philippon Research Institute, Vail, Colorado, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Civitarese
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.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: LaPrade
authors.affiliation: Steadman Philippon Research Institute, Vail, Colorado, USA.
authors.forename: Marco
authors.initials: M
authors.lastname: Nitri
authors.affiliation: Steadman Philippon Research Institute, Vail, Colorado, USA.
authors.forename: Coen A
authors.initials: CA
authors.lastname: Wijdicks
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
mesh_terms: D000328:Adult; D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000379:methods; D001696:Biomechanical Phenomena; D002357:Cartilage Diseases / Q000503:physiopathology / Q000601:surgery; D002358:Cartilage, Articular / Q000502:physiology / Q000601:surgery; D005260:Female; D006801:Humans; D007718:Knee Injuries / Q000601:surgery; D007719:Knee Joint / Q000601:surgery; D022125:Lacerations / Q000601:surgery; D008297:Male; D008592:Menisci, Tibial / Q000502:physiology / Q000601:surgery; D020370:Osteoarthritis, Knee / Q000209:etiology; D012421:Rupture / Q000503:physiopathology / Q000601:surgery; D013536:Suture Techniques; D013537:Sutures; D000070600:Tibial Meniscus Injuries; D014945:Wound Healing / Q000502:physiology
keywords: 2-tunnel; mattress suture; medial meniscus repair; radial tear