Continuous Vertical Inside-Out Versus Traditional Vertical Inside-Out Meniscal Repair: A Biomechanical Comparison

José Leonardo Rocha de Faria; Arthur Paiva Grimaldi Santos; Douglas Mello Pavão; Mariana Radulski; Ana Carolina Leal; Ari Digiácomo Ocampo More; Alan de Paula Mozella; João Antonio Matheus Guimarães; Robert F LaPrade; Carlos Rodrigo de Mello Roesler; Rodrigo Salim

doi:10.1177/23259671231209951

Continuous Vertical Inside-Out Versus Traditional Vertical Inside-Out Meniscal Repair: A Biomechanical Comparison

Orthop J Sports Med. 2023 Nov 13;11(11):23259671231209951. doi: 10.1177/23259671231209951. eCollection 2023 Nov.

Authors

José Leonardo Rocha de Faria^{1

2}, Arthur Paiva Grimaldi Santos³, Douglas Mello Pavão^{1

2}, Mariana Radulski⁴, Ana Carolina Leal⁵, Ari Digiácomo Ocampo More^{3

4}, Alan de Paula Mozella^{1

2}, João Antonio Matheus Guimarães⁵, Robert F LaPrade^{6

7}, Carlos Rodrigo de Mello Roesler³, Rodrigo Salim²

Affiliations

¹ Knee Surgery Center, National Institute of Traumatology and Orthopedics (INTO), Rio de Janeiro, Brazil.
² School of Medicine from University of São Paulo (USP), Ribeirão Preto, São Paulo, Brazil.
³ Biomechanical Engineering Laboratory of Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil.
⁴ Medical School of Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil.
⁵ Research Division, National Institute of Traumatology and Orthopedics (INTO), Rio de Janeiro, Brazil.
⁶ Twin Cities Orthopaedics, Edina, Minnesota, USA.
⁷ University of Minnesota Medical School, Minneapolis, Minnesota, USA.

Abstract

Background: Biomechanical assessment of meniscal repairs is essential for evaluating different meniscal suturing methods and techniques. The continuous meniscal suture technique is a newer method of meniscal repair that may have biomechanical differences compared with traditional techniques.

Purpose: To evaluate the displacement, stiffness after cyclical loading, and load to failure for a continuous vertical inside-out meniscal suture versus a traditional vertical inside-out meniscal suture in a porcine medial meniscus.

Study design: Controlled laboratory study.

Methods: A total of 28 porcine knees were acquired and divided into 2 test groups of 14 medial meniscus each. A 2.0-cm longitudinal red-white zone cut was made in the body of the medial meniscus for each knee. The continuous suture (CS) group received 4 vertical stitches performed with a continuous vertical meniscal suture technique, and the inside-out suture (IO) group received a traditional vertical suture with 4 stitches. Two traction tapes were passed between the sutures and positioned in the biomechanical testing fixture device. Each specimen underwent load-to-failure testing at 5 mm/s, and displacement, system stiffness, and maximum load to failure were compared between the groups.

Results: The displacement after the cyclic test was 0.53 ± 0.12 and 0.48 ± 0.07 mm for the CS and IO groups, respectively. There was no significant difference between the groups (P = .2792). The stiffness at the ultimate load testing was 36.3 ± 1.9 and 35.3 ± 2.4 N/mm for groups CS and IO, respectively, with no significant difference between the groups (P = .2557). In the load-to-failure test, the ultimate load was 218.2 ± 63.9 and 238.3 ± 71.3 N in the CS and IO groups, respectively, with no significant group differences (P = .3062).

Conclusion: A continuous vertical meniscal suture created a configuration for treating longitudinal meniscal lesions that was beneficial and biomechanically similar to a traditional vertical suture technique.

Clinical relevance: The study findings indicate that use of the continuous vertical inside-out meniscal suture technique is a possible therapeutic option.

Keywords: biomechanics; inside-out; meniscal repair; primary fixation.