Summary

This current study biomechanically compares vertical mattress and cross-stitch suture techniques, and single- and double-row configurations, in a bucket-handle medial meniscus tear model, analyzing contact area, average contact pressure and peak contact pressure.

Abstract

Background

Due to a variety of suturing techniques for bucket-handle meniscal repair, it is important to assess which suturing technique best restores native biomechanics.
Purpose/Hypothesis: To biomechanically compare vertical mattress and cross-stitch suture techniques, and single- and double-row configurations, in a bucket-handle medial meniscus tear model, analyzing contact area, average contact pressure and peak contact pressure. Our hypothesis was that cross-stitch double-row would be the best configuration, mainly at high flexion angles.
Study Design: Controlled laboratory study

Methods

Ten matched pairs of human cadaver knees were randomly assigned to vertical (n = 10) or cross-stitch (n = 10) repair groups. Each knee underwent four consecutive testing conditions: (1) intact, (2) displaced bucket-handle tear, (3) single-row configuration on the femoral meniscus surface, and (4) double-row configuration (repair of both femoral and tibial meniscus surfaces). Knees were loaded with a 1000 N axial compressive force at 0°, 30°, 60°, 90° and 120° of flexion for each condition. Resultant medial compartment contact area, average contact pressure, and peak contact pressure data were used to evaluate the two repair techniques.

Results

Intact state contact area was not restored at 0o (P = 0.027) for the vertical double-row configuration and at 0o (P = 0.032), 60o (P < 0.001) and 90o (P = 0.007) of flexion for the cross-stitch double-row configuration. No significant differences were found in average contact pressure and peak contact pressure between the intact state and the vertical mattress and cross-stitch repairs with either single- and double-row configurations at any flexion angles. When comparing the vertical and cross-stich repairs across all flexion angles simultaneously, no significant differences were observed in single-row configurations, but in double-row configurations, cross-stitch repair resulted in a significantly decreased contact area, average contact pressure and peak contact pressure (all P < 0.001).

Conclusion

Single- and double-row configurations of both vertical mattress and cross-stitch inside-out meniscal repair techniques restored native tibiofemoral pressure after a medial meniscus bucket-handle tear at all assessed knee flexion angles. Despite decreased contact area using a double-row configuration, mainly related to the cross-stitch repair, in comparison to the intact state, the cross-stitch double-row repair led to decreased pressure in comparison to the vertical double-row repair.