Biomechanical Testing of Meniscal Repair Techniques in Human Cadaveric Menisci (SS‐30) (2011)

Introduction The established gold standard for meniscal repair has been a braided polyester suture inside‐out repair. Recent technological advances have expanded the surgical options for repair of a torn meniscus, especially the development of all‐inside meniscal repair devices using ultra high‐molecular weight polyethylene (UHMWPE) containing suture. Modified versions of the first generation of UHMWPE suture repair devices have been recently released. The hypothesis was that recent modifications in the first generation UHMWPE suture devices have resulted in improved repair characteristics. The purpose of this study was to compare the biomechanical properties of these newly‐released, modified meniscal repair devices to the traditional braided polyester suture and UHMWPE containing suture repair in human cadaveric menisci. Methods Vertical longitudinal tears were made 3 millimeters from the periphery in fresh‐frozen adult human menisci to simulate a bucket‐handle meniscus tear. Each tear was then repaired a single repair technique. Group 1 menisci were repaired using a vertical suture of No. 2‐0 Ethibond (Ethicon, Somerville, NJ). Group 2 menisci were repaired using a vertical suture of No. 2‐0 Orthocord (DePuy‐Mitek, Raynham, MA). Group 3 menisci were repaired using a single OmniSpan device with No. 2‐0 Orthocord suture (DePuy‐Mitek) in a vertical mattress configuration. Group 4 menisci were repaired using a single MarXmen device with MaxBraid suture (Biomet Sports Medicine, Warsaw, IN) in a vertical mattress configuration. Group 5 menisci were repaired using a single Meniscal Cinch device with No. 2‐0 FiberWire suture (Arthrex, Naples, FL). Group 6 menisci were repaired using a Linvatec Sequent prototype device with No. 0 Hi‐Fi suture in a “V” suture configuration. Using a mechanical testing machine, all samples were preloaded at 5N and cycled 200 times between 5 and 50 N. Those specimens that survived were destructively tested at 5 mm/min. Endpoints included maximum load, cycles to failure, and failure mode. Results The following mean failure loads were determined: Ethibond suture (73 N); Orthocord suture (88 N); OmniSpan (88 N); MarXmen (54 N); Meniscal Cinch (71 N); Sequent prototype device (64 N). The mean number of cycles completed were calculated for the Ethibond suture (140 cycles), Orthocord suture (160 cycles), OmniSpan (121 cycles), MarXmen (37 cycles), Meniscal Cinch (140 cycles), and the Sequent prototype device (110 cycles). When compared to the Ethibond suture repair, the Orthocord suture, OmniSpan, Meniscal Cinch, and Sequent device repairs did not exhibit a statistically significant difference. However, the Ethibond suture repair was superior to the MarXmen with regards to both load to failure (p=0.03) and cycles completed (p=0.01). Conclusion The biomechanical properties of meniscal repairs using the OmniSpan, Meniscal Cinch, and Sequent all‐inside meniscal repair devices are equivalent to traditional suture repair techniques. However, the MarXmen meniscal repair device demonstrated significantly lower failure loads and survived less cyclic loading in the human cadaver meniscus.