Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA.
Am J Sports Med. 2011 Oct;39(10):2141-6. doi: 10.1177/0363546511413250. Epub 2011 Jul 15.
Meniscal root tears have attracted increasing interest in recent years. Fixation is an important factor for rehabilitation and avoidance of early failure. Suture fixations have been the most commonly used techniques. The current study aimed to evaluate the maximum failure load of the native meniscal roots (anteromedial, posteromedial, anterolateral, and posterolateral) and of 3 commonly used meniscal root fixation techniques (2 simple stitches, modified Kessler stitch, and loop stitch).
(1) There will be no difference in maximum failure load between the native meniscal roots. (2) The loop stitch will sustain the greatest maximum load to failure, followed by the modified Kessler stitch and the 2 simple stitches. (3) The maximum failure load of the native meniscal roots will not be restored by the tested fixation methods.
Controlled laboratory study.
The maximum failure load of the 4 human native meniscal roots was evaluated using 64 human meniscal roots. Additionally, the maximum failure load of the 3 fixation techniques was evaluated on 24 meniscal roots: (1) 2 simple stitches, (2) modified Kessler stitch, and (3) loop stitch using a suture shuttle.
The average maximum failure load of the native meniscal roots was 594 ± 241 N (anterolateral: 692 ± 304 N; posterolateral: 648 ± 140 N; anteromedial: 407 ± 180 N; posteromedial: 678 ± 200 N). The anteromedial root was significantly weaker than the posterolateral and posteromedial roots (P = .04 and P = .01, respectively). Regarding fixation techniques, the maximum failure load of the 2 simple stitches was 64.1 ± 22.5 N, the modified Kessler stitch was 142.6 ± 33.3 N, and the loop was 100.9 ± 41.6 N. None of the fixation techniques recreated the strength of the native roots.
The native anterolateral root was the strongest meniscal root, and the anteromedial root was the weakest meniscal root. Regarding primary fixation strength, the modified Kessler stitch was the strongest technique compared with the loop and the 2 simple stitches.
None of our tested fixation methods restored the strength of native meniscal roots. Thus, rehabilitation after meniscal root fixation should proceed cautiously.
近年来，半月板根部撕裂越来越受到关注。固定是康复和避免早期失败的重要因素。缝合固定是最常用的技术。本研究旨在评估原生半月板根部（前内侧、后内侧、前外侧和后外侧）和 3 种常用半月板根部固定技术（2 种简单缝线、改良 Kessler 缝合和环形缝合）的最大失效负载。
（1）原生半月板根部之间的最大失效负载没有差异。（2）环形缝合将承受最大的失效负载，其次是改良 Kessler 缝合和 2 种简单缝线。（3）测试固定方法不会恢复原生半月板根部的最大失效负载。
对照实验室研究。
使用 64 个人类半月板根部评估 4 个人类原生半月板根部的最大失效负载。此外，还评估了 3 种固定技术的最大失效负载，共使用 24 个人半月板根部：（1）2 种简单缝线，（2）改良 Kessler 缝合，（3）使用缝线梭的环形缝合。
原生半月板根部的平均最大失效负载为 594 ± 241 N（前外侧：692 ± 304 N；后外侧：648 ± 140 N；前内侧：407 ± 180 N；后内侧：678 ± 200 N）。前内侧根部明显弱于后外侧和后内侧根部（P =.04 和 P =.01）。关于固定技术，2 种简单缝线的最大失效负载为 64.1 ± 22.5 N，改良 Kessler 缝合为 142.6 ± 33.3 N，环形缝合为 100.9 ± 41.6 N。没有一种固定技术能够重建原生根部的强度。
原生前外侧根部是最强的半月板根部，而前内侧根部是最弱的半月板根部。在原发性固定强度方面，改良 Kessler 缝合与环形和 2 种简单缝线相比是最强的技术。
我们测试的固定方法都没有恢复原生半月板根部的强度。因此，半月板根部固定后的康复应谨慎进行。
