Summary

Several repair techniques have been described though there is a lack of consensus regarding which techniques are biomechanically superior.

Abstract

Background

Meniscal root repairs require specialized fixation to restore hoop stresses. Several repair techniques have been described though there is a lack of consensus regarding which techniques are biomechanically superior.

Purpose

To systematically review the literature regarding the biomechanical properties of meniscal root repairs based on suture configuration, suture material, fixation method (transtibial pullout repair (TPR) and suture anchor repair (SAR)), suture configuration and suture material and shape of TPR’s, and location of fixation (anatomic versus non-anatomic).

Methods

A systematic review of multiple databases was performed. The inclusion criteria included English language, studies relevant to meniscal root repairs, studies comparing two or more different discrete techniques, posterior root repairs, controlled laboratory studies, human cadaveric or animal studies. Abstracts, case reports, prospective and retrospective cohort studies, case-control studies, and prior systematic reviews and meta-analyses, meniscal body repairs were excluded.

Results

Seventeen controlled laboratory studies were included for final analysis. There is no consensus on biomechanical superiority between TPR and SAR. For TPR, there is no significant difference between 1 and 2 tibial tunnels. Non-anatomic repairs result in significantly lower joint surface contact areas and higher contact pressures, but suture placement further away from the root results in higher maximum load to failure. Two-suture repair has greater maximum load to failure compared to one suture. Use of more than two sutures has diminishing returns. The modified Mason-Allen suture configuration is superior to simple-suture configuration, but there is no consensus regarding the superiority or feasibility of more complex sutures. There is no consensus on superiority of a single suture material or shape.

Conclusions

Anatomic meniscus root repairs with either TPR or SAR have better joint surface contact pressures and contact surface areas than non-anatomic repairs. The use of two sutures has better fixation than one suture. There is evidence that the modified Mason-Allen configuration is superior to a simple suture configuration in a TPR, though the benefits of more complicated configurations are unclear.