Anz Adam W, Branch Eric A, Saliman Justin D
Andrews Orthopaedic and Sports Medicine Center, Gulf Breeze, Florida, USA Andrews Research and Education Institute, Gulf Breeze, Florida, USA
Florida State University College of Medicine, Tallahassee, Florida, USA.
Am J Sports Med. 2014 Nov;42(11):2699-706. doi: 10.1177/0363546514549445. Epub 2014 Sep 15.
Complete meniscal root tears render the meniscus nonfunctional. Repair constructs have been presented and tested; however, prior studies have evaluated suture patterns placed ex vivo without simulating an in vivo surgical setting. This study introduces a new double-locking loop suture pattern and compares its biomechanical properties and execution time with commonly used suture patterns. All constructs were performed using an all-inside arthroscopic technique.
Complex suture repair constructs have higher failure loads, stiffness, and execution times compared with simple constructs.
Controlled laboratory study.
Sutures were placed arthroscopically into the posterior horn root region of the medial and lateral menisci in 21 cadaveric knees. Four repair constructs were evaluated: 2 simple sutures (2SS), 1 inverted mattress suture (1MS), 1 double-locking loop suture (1DLS), and 2 double-locking loop sutures (2DLS). In total, 40 posterior meniscal roots were tested, with 10 trials for each construct. After arthroscopic placement of the root repair constructs, each meniscus was explanted and tested to failure on a uniaxial materials testing machine. The Kruskal-Wallis test was used to evaluate for the significance of maximum failure loads and stiffness between groups.
The mean maximum failure loads were 137 ± 49 N (2SS), 126 ± 44 N (1MS), 186 ± 43 N (1DLS), and 368 ± 76 N (2DLS). Interconstruct comparison revealed a statistical difference between 2DLS and all 3 remaining constructs (P < .01) and 1DLS when compared with 2SS and 1MS (P < .01 for both). Statistical significance was not found between 2SS and 1MS (P = .8). The mean times for repair of the 4 fixation techniques were 1.8 ± 0.9 minutes (2SS), 2.4 ± 1.9 minutes (1MS), 4.7 ± 2.0 minutes (1DLS), and 5.4 ± 0.6 minutes (2DLS).
The double-locking loop suture repair technique had significantly higher failure loads compared with the 3 other methods tested. As the complexity of repair constructs increases, failure loads and surgical times increase.
Complex suture patterns can be placed via an all-inside arthroscopic technique delivering higher failure loads for meniscal root repair with little increase in surgical time.
半月板根部完全撕裂会导致半月板失去功能。已有修复结构被提出并进行了测试；然而，先前的研究评估的是体外放置的缝合模式，并未模拟体内手术环境。本研究引入一种新的双锁定环缝合模式，并将其生物力学性能和操作时间与常用的缝合模式进行比较。所有结构均采用全关节镜技术完成。
与简单结构相比，复杂的缝合修复结构具有更高的破坏载荷、刚度和操作时间。
对照实验室研究。
在21具尸体膝关节的内外侧半月板后角根部区域进行关节镜下缝合。评估了四种修复结构：2种简单缝合（2SS）、1种倒“8”字缝合（1MS）、1种双锁定环缝合（1DLS）和2种双锁定环缝合（2DLS）。总共测试了40个半月板后根，每种结构进行10次试验。在关节镜下放置根部修复结构后，将每个半月板取出并在单轴材料试验机上测试至破坏。采用Kruskal-Wallis检验评估各组最大破坏载荷和刚度的显著性。
平均最大破坏载荷分别为137±49N（2SS）、126±44N（1MS）、186±43N（1DLS）和368±76N（2DLS）。结构间比较显示，2DLS与其余3种结构之间存在统计学差异（P<.01），1DLS与2SS和1MS相比也存在统计学差异（两者P<.01）。2SS和1MS之间未发现统计学显著性（P = 0.8）。4种固定技术的平均修复时间分别为1.8±0.9分钟（2SS）、2.4±1.9分钟（1MS）、4.7±2.0分钟（1DLS）和5.4±0.6分钟（2DLS）。
与其他3种测试方法相比，双锁定环缝合修复技术具有显著更高的破坏载荷。随着修复结构复杂性的增加，破坏载荷和手术时间也会增加。
复杂的缝合模式可通过全关节镜技术放置，为半月板根部修复提供更高的破坏载荷，且手术时间增加不多。
