Biomechanical comparison of four tibial fixation techniques for meniscal root sutures in posterior medial meniscus root repair: A porcine study

Shen-Han Wu; Tsu-Te Yeh; Wei-Chun Hsu; Alexander T H Wu; Guoan Li; Chih-Hwa Chen; Chian-Her Lee; Jia-Lin Wu

doi:10.1016/j.jot.2020.01.006

Biomechanical comparison of four tibial fixation techniques for meniscal root sutures in posterior medial meniscus root repair: A porcine study

J Orthop Translat. 2020 Feb 17:24:144-149. doi: 10.1016/j.jot.2020.01.006. eCollection 2020 Sep.

Authors

Shen-Han Wu^{1

2}, Tsu-Te Yeh³, Wei-Chun Hsu⁴, Alexander T H Wu^{5

6}, Guoan Li⁷, Chih-Hwa Chen^{8

9

10}, Chian-Her Lee^{1

2}, Jia-Lin Wu^{1

2}

Affiliations

¹ Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
² Department of Orthopedics, Taipei Medical University Hospital, Taipei, Taiwan.
³ Department of Orthopedic Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
⁴ Graduate Institute of Biomedical Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan.
⁵ The PhD Program for Translational Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.
⁶ Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan.
⁷ Bioengineering Laboratory, Department of Orthopedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
⁸ Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.
⁹ School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
¹⁰ School of Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan.

Abstract

Objective: This study hypothesized that the suture anchor of tibial fixation method of PMMR repair technique is the main factor which reduce the gap formation or over displacement of tear site in initial healing, and then investigated the fixation stability of 4 different tibial fixations through cyclic and ultimate failure load testing of meniscal root sutures.

Methods: Twenty-four porcine tibiae with intact medial meniscus roots were randomly assigned into 4 groups: transosseous suture, washer, suture anchor, or screw with washer. Each sample underwent cyclic loading followed by a load-to-failure test. Displacement, maximum load to failure, stiffness, and elongation at failure load were recorded.

Results: The maximum average load and displacement at failure for each of the repair groups were as follows: transosseous suture, 232.8 N and 12.16 mm; washer, 189.9 N and 21.5 mm; suture anchor, 140.6 N and 13.8 mm; and screw with washer, 167.9 N and 18.9 mm. The maximum stiffness values for each of the repair groups were as follows: transosseous suture, 19.5 ± 0.7 N/mm; washer, 21.5 ± 1.4 N/mm; suture anchor, 13.8 ± 0.7 N/mm; and screw with washer, 18.9 ± 3.9 N/mm. The mean elongation across the repairs for each of the repair groups after 1000 loading cycles was: transosseous suture, 3.74 ± 0.28 mm; washer, 3.04 ± 0.13 mm; suture anchor, 2.25 ± 0.33 mm; and screw with washer, 2.43 ± 0.19 mm. The mean elongation was significantly less with the suture anchor than with the other techniques (p < .05).

Conclusion: Under physiological loading, our results indicate that a slower rehabilitation program with limited flexion and only partial weight bearing is advised when using a suture anchor because of the lower maximum load and stiffness.

The translational potential of this article: Tibial fixation using a washer or a screw with a washer is an effective and cost-saving technique when an option is required with high stiffness and low displacement at failure.

Keywords: Meniscus–suture interface; Posterior medial meniscus root repair; Transtibial pull-out fixation.