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A Novel Approach to Segmental Meniscal Repair Improves Ultimate Strength and Resistance to Cyclic Fatigue
Hisham Omar1, Akbar N Syed2, Kevin Landrum2
1Department of Biomedical Engineering, University of Delaware, Newark, Delaware, USA.
Background:
Meniscal tears are common sports-related injuries, and surgical repairs continue to have undesirable clinical outcomes. Meniscal allograft transplantation is limited by the availability of suitable age-matched and size-matched allografts and poor long-term survival. Segmental meniscal transplantation may improve outcomes by preserving the meniscotibial ligament complex; however, little is known about how surgical techniques influence the biomechanics of such reconstructions.
Purpose:
To evaluate the biomechanical performance of 2 surgical reconstruction strategies for segmental meniscal transplantation using a cadaveric bovine meniscus model.
Study Design:
Controlled laboratory study.
Methods:
A total of 24 bovine meniscus explants (12 medial, 12 lateral) underwent 2 repair techniques (n = 12 per group; 6 medial and 6 lateral per group): (1) Repair 1, using 2 hashtag, 1 vertical rip-stop, and 2 luggage tag sutures; and (2) Repair 2, using 4 luggage, 1 vertical mattress, and 2 horizontal mattress sutures. Half of the specimens (n = 12) underwent quasi-static uniaxial tensile testing to failure; the remaining half underwent 1000 loading cycles before failure. Outcomes included stiffness, maximum force, failure mode, construct deformation, and cyclic survival.
Results:
Repair 1 demonstrated significantly higher ultimate failure loads in both static (311.9 ± 26.2 N vs. 209.5 ± 82.6 N; P = .016) and dynamic testing (339 ± 43 N vs. 181 ± 89 N; P = .003) compared with Repair 2. During cyclic loading, 33% of Repair 2 specimens did not complete the full protocol. Cyclic stiffness and construct deformation favored Repair 1, although differences between groups did not reach significance at any individual cycle count.
Conclusion:
A surgical technique combining hashtag sutures with luggage-tag fixation (Repair 1) increased ultimate failure load and reduced the likelihood of cyclic failure, suggesting it may enhance the stability and durability of segmental meniscal repairs.
Clinical Relevance:
Robust fixation of segmental meniscal repairs may improve surgical outcomes for meniscal deficiency and offer an alternative to full meniscal transplantation.