Summary

All-inside meniscus suture device(Ultra Fast-FixTM) showed comparable biomechanical properties to inside-out horizontal suture in repair of meniscus radial tear.

Abstract

Background

For successful meniscal healing of radial tears, primary mechanical stability of repair technique is one of the essential requirements. All-inside meniscus suture device(Ultra Fast-FixTM)is being used widely and its repair strength in meniscus longitudinal tear is well documented. However, biomechanical comparison horizontal suture using all-inside suture device(Ultra Fast-FixTM) and horizontal inside-out suture in meniscal repair of radial tear was not performed yet. It is hypsthesized that all-inside suture device (Ultra Fast-FixTM) can show comparable suture strength to horizontal inside-out suture in meniscal repair of radial tear. We also assumed that biomechanical comparison can be differ among the degree of radial tear, complete or incomplete tear.

Purpose

The aim of this biomechanical study was to compare the suture strength of all-inside suture device (Ultra Fast-FixTM) and inside-out horizontal suture in the two different senario of meniscus radial tear, complete or incomplete tear.

Material & Method: Biomechanical test was performed on 80 fresh-frozen porcrine lateral menisci (2groups, n=20 in each group, 2sets of experiment). In complete tear scenario, complete radial tear was made at the mid-portion of each meniscus. In group A, menisci were repaired with parallel 2 stitch of inside-out horizontal sutures for control. In group B, menisci were repaired with 2 stitch of all-inside suture device(Ultra Fast-FixTM) in horizontal fashion. Suture attachments were located at 5mm from the tear surface and 5mm and 10mm from the rim in all cases. In incomplete tear scenario, radial tear was made at the mid-portion of each meniscus remaining 2.5mm of peripheral rim. Other procedures were same with complete scenario. The specimens were cyclically loaded 500 times between 5 and 20 N ,then gap of tear surface was measured. After completion of cyclic load testing, specimens were loaded to failure.

Results

In complete radial tear scenario, the mean maximum failure load were 76±15N(inside-out horizontal suture) and 60±17N(all-inside suture device) . The mean displacement after a 500-cycle loading test were 5.23±1.82mm(inside-out horizontal suture) and 5.56±1.87mm(all-inside suture device). In incomplete radial tear scenario, the mean maximum failure load were 74±14N(inside-out horizontal suture) and 76±13N(all-inside suture device) . The mean displacement after a 500-cycle loading test were 3.64±1.45mm(inside-out horizontal suture) and 3.22±1.23mm(all-inside suture device). In complete radial tear scenario, failure load of all-inside suture device(Ultra Fast-FixTM) was significantly lower than that inside-out horizontal suture . However, there was no difference between gap distance between the two groups. In incomplete radial tear scenario, both of failure load and gap distance in all-inside suture device(Ultra Fast-FixTM) group were comparable to that of inside-out horizontal suture group.

Conclusion

Generally, all-inside meniscus suture device(Ultra Fast-FixTM) showed comparable biomechanical properties to inside-out horizontal suture in repair of meniscus radial tear. All-inside meniscus suture device(Ultra Fast-FixTM) showed more superior resistance to gap formation rather than failure load, especially in incomplete radial tear.