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Am J Sports Med. 2019 Apr;47(5):1194-1202. doi: 10.1177/0363546519830402. Epub 2019 Mar 21.

Biomechanical Comparison of Vertical Mattress and Cross-stitch Suture Techniques and Single- and Double-Row Configurations for the Treatment of Bucket-Handle Medial Meniscal Tears.

Author information

1
Steadman Philippon Research Institute, Vail, Colorado, USA.
2
Departament of Orthopedics and Traumatology, Universidade Federal de São Paulo, São Paulo, Brazil.
3
Instituto Brasil de Tecnologias da Saúde, Rio de Janeiro, Brazil.
4
Hospital Israelita Albert Einstein, São Paulo, Brazil.
5
The Steadman Clinic, Vail, Colorado, USA.
6
Twin Cities Orthopedics, Edina, Minnesota, USA.

Abstract

BACKGROUND::

Given the 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, in single- and double-row configurations, in their ability to restore native knee kinematics in a bucket-handle medial meniscal tear model. The hypothesis was that there would be no difference between the vertical mattress and cross-stitch double-row suture techniques but that the double-row technique would provide significantly improved biomechanical parameters versus the single-row technique.

STUDY DESIGN::

Controlled laboratory study.

METHODS::

Ten matched pairs of human cadaver knees were randomly assigned to the vertical mattress (n = 10) or cross-stitch (n = 10) repair group. Each knee underwent 4 consecutive testing conditions: (1) intact, (2) displaced bucket-handle tear, (3) single-row suture configuration on the femoral meniscus surface, and (4) double-row suture configuration (repair of 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 recorded.

RESULTS::

Intact state contact area was not restored at 0° ( P = .027) for the vertical double-row configuration and at 0° ( P = .032), 60° ( P < .001), and 90° ( P = .007) of flexion for the cross-stitch double-row configuration. No significant differences were found in the average contact pressure and peak contact pressure between the intact state and the vertical mattress and cross-stitch repairs with single- and double-row configurations at any flexion angles. When the vertical and cross-stich repairs were compared across all flexion angles, 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 < .001).

CONCLUSION::

Single- and double-row configurations of the vertical mattress and cross-stitch inside-out meniscal repair techniques restored native tibiofemoral pressure after a medial meniscal bucket-handle tear at all assessed knee flexion angles. Despite decreased contact area with a double-row configuration, mainly related to the cross-stitch repair, in comparison with the intact state, the cross-stitch double-row repair led to decreased pressure as compared with the vertical double-row repair. These findings are applicable only at the time of the surgery, as the biological effects of healing were not considered.

CLINICAL RELEVANCE::

Medial meniscal bucket-handle tears may be repaired with the single- or double-row configuration of vertical mattress or cross-stitch sutures.

KEYWORDS:

Tekscan pressure sensors; bucket-handle tear; in situ repair; medial compartment load; medial meniscus

PMID:
30897004
DOI:
10.1177/0363546519830402

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