## 4 Discussion
This orientation of the meniscal horn aimed to maximize tissue damage, representing a conservative criterion for detecting the maximum load the repair could withstand. A single simple suture was utilized at the meniscal horn, deviating from common surgical options. This choice facilitates computation of the forces acting on the tissue-suture interface. Multiple stitches distribute the pulling load among them, posing challenges for achieving uniform distribution under laboratory conditions. Despite neither being the most resistant nor the most common suture technique for meniscal root repair, the use of a simple stitch eases the quantification of the meniscus-thread contact area, essential for calculating stress at the suture-meniscus interface. This simplicity minimizes the impact of meniscus anatomy or surgeon performance compared to more complex suture techniques. To accurately detect cut-out initiation, automatic detection using a previously validated method [46] was utilized and further verified by checking the recorded video images. The results confirmed that, as formerly reported [46], tearing was initiated slightly before the first local maximum of the load-deformation curve. In the scientific literature, the maximum force borne by the specimen, \(F_{u}\), has usually been selected as the parameter to characterize the failure of repaired menisci under suture-induced traction. The authors consider it more relevant to study the cut-out initiation point, i.e., \(F_{c}\) at the specimen level or \(S_{c}\) at the tissue level, although \(F_{u}\) has also been calculated for comparison purposes. \(F_{u}\) was found to be higher than \(F_{c}\) by nearly 30% for older human menisci and approximately 20% for the porcine group. After cut-out initiation, the progression of the tear may follow different paths within the meniscus of variable thickness. Consequently, the load-deformation curve exhibited a highly heterogeneous pattern from cut-out initiation to the absolute maximum force. This heterogeneity under laboratory conditions is expected to be more pronounced In a repaired knee subjected to physiological loads. Therefore, we believe that the cut-out initiation provides a better basis for comparing results between different groups because it is the starting point of the loss of structural integrity of the sample and it is less influenced by the post-tearing initiation trajectory. Cryoprotectant solutions have been proposed to preserve biological tissues from damage caused by freezing, but we discarded their use for two main reasons. Primarily, they are not customarily used for preserving specimens in either of the two surrogate models of the human meniscus that our study focuses on. Additionally, there is a lack of data on their ability to maintain the mechanical properties of the suture meniscal horn better than the preservation method we used, particularly concerning elasticity and resistance. Some studies have examined the resistance of meniscal horns to suture-induced traction, focusing on assessing various suturing techniques and devices for root reattachment. [PERSON] et al. conducted a load-to-failure test on human menisci aged 46-64 years using two simple stitches with a #2 UHMWPE surgical suture on the posterior horn [37]. Despite differences in testing protocols, their reported values align with our findings for the young group, with a mean initial peak force of 137 \(\pm\) 49 N for two stitches compared to our \(F_{c}\) of 60.13 \(\pm\) 19.91 N with a single stitch. In accordance with our results, the initial peak force must be very close to our \(F_{c}\). [PERSON] et al. reported an ultimate load of 94.29 \(\pm\) 7.99 N for a group of posterior medial menisci with a mean age of 54 \(\pm\) 4 years using two simple #2 sutures [52]. This result is also compatible with our findings, considering \(F_{u}\) values of 75.08 \(\pm\) 26.62 N for the young group and 70.49 \(\pm\) 16.92 N for the older group, acknowledging the use of two stitches and prior sample weakening by 1000 cycles of under-critical load.