Biomechanics of Meniscus Tears and Repair Techniques

Treatment of meniscus injuries can have a substantial effect on the intra-articular biomechanics and long-term function of the knee. Meniscus repair has become a more favorable treatment option as prior studies have demonstrated a strong correlation between meniscal preservation and restoration of intra-articular contact pressure and decreased progression of arthritis. The goal of meniscus repair is to provide a stable load bearing construct to allow for meniscal healing. Repair constructs vary by tear pattern, tear location, and repair technique. The purpose of this review is to highlight the biomechanical strength of meniscus repair techniques for frequently encountered meniscus tears.

Recent literature reports that meniscus tear type and location influence which repair technique would provide the most stable construct. Prior studies report that inside-out meniscus repair is the gold standard for longitudinal tears, but more recent literature on modern all-inside repair devices suggest improvements with all-inside devices. Radial tears repaired with vertical mattress rip stop sutures added to horizontal mattress repair sutures have less suture cut-out and improved stability. Root tears repaired with a locking suture configuration result in biomechanical strength similar to a native meniscus and addition of a centralization suture may further improve this construct. No single repair technique is superior to others across meniscus repair types. Surgeons need to thoroughly understand various tear patterns and be familiar with a variety of repair techniques in order to provide the most stable construct for meniscus repair.