Iuchi Ryo, Mae Tatsuo, Shino Konsei, Matsuo Tomohiko, Yoshikawa Hideki, Nakata Ken
Sports Orthop. Center, Yukioka Hospital, Osaka, Japan.
Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
J Exp Orthop. 2017 Dec;4(1):2. doi: 10.1186/s40634-017-0075-7. Epub 2017 Jan 25.
All of previous biomechanical studies on meniscal repair have examined the meniscus itself without synovial membrane and capsule, although in the clinical setting, the meniscal repair is generally performed including capsule. Therefore, biomechanical properties of transcapsular meniscal repair are unclear. Thus, this study aimed to clarify the biomechanical properties of transcapsular meniscal repair.
In 70 porcine femur-medial meniscus-tibia complexes with capsules, longitudinal meniscal tears were repaired using different suture techniques (inside-out or all-inside technique), suture methods (vertical or horizontal methods), and numbers of sutures (single or double). A cyclic loading test between 5 and 20 N for 300 cycles was performed followed by a load-to-failure test.
Tears repaired by the all-inside technique presented significantly larger widening (0.88 ± 0.38 mm) than those by the inside-out technique (0.51 ± 0.39 mm) during the cyclic loading test (P = 0.035). The horizontal suture presented significantly lower ultimate failure load (62.5 ± 15.5 N) in the all-inside technique than in the vertical suture (79.7 ± 13.0 N; P = 0.018). The stacked suture had a significantly higher failure load (104.6 ± 12.5 N) than the parallel suture (83.3 ± 12.6 N; P = 0.001). Furthermore, the double suture presented significantly higher failure loads (83.3 ± 12.6 N and 104.6 ± 20.4 N) than the single suture with both inside-out (58.8 ± 8.3 N; P = 0.001) and all-inside (79.7 ± 13.0 N; P = 0.022) techniques.
Upon comparison of the suture techniques, the inside-out technique provided a more stable fixation at the repair site than the all-inside technique during the cyclic test. Among the suture methods, the vertical suture had more desirable biomechanical properties than the horizontal suture as demonstrated by smaller widening during the cyclic test and the larger load to failure. The stacked suture created a stronger fixation than the parallel suture. In terms of the number of sutures, the double suture had superior biomechanical properties compared with the single suture.
以往所有关于半月板修复的生物力学研究均未涉及滑膜和关节囊，仅对半月板本身进行了研究，然而在临床实践中，半月板修复通常是连同关节囊一起进行的。因此，经关节囊半月板修复的生物力学特性尚不清楚。本研究旨在阐明经关节囊半月板修复的生物力学特性。
在70个带有关节囊的猪股骨-内侧半月板-胫骨复合体上，采用不同的缝合技术（由外向内或全内技术）、缝合方法（垂直或水平方法）以及缝合针数（单针或双针）修复半月板纵向撕裂。先进行5至20牛的循环加载试验，持续300个循环，随后进行破坏载荷试验。
在循环加载试验中，采用全内技术修复的撕裂处增宽幅度（0.88±0.38毫米）显著大于采用由外向内技术修复的撕裂处（0.51±0.39毫米）（P = 0.035）。在全内技术中，水平缝合的极限破坏载荷（62.5±15.5牛）显著低于垂直缝合（79.7±13.0牛；P = 0.018）。叠加缝合的破坏载荷（104.6±12.5牛）显著高于平行缝合（83.3±12.6牛；P = 0.001）。此外，无论是采用由外向内技术（58.8±8.3牛；P = 0.001）还是全内技术（79.7±13.0牛；P = 0.022），双针缝合的破坏载荷均显著高于单针缝合。
比较缝合技术发现，在循环试验中，由外向内技术在修复部位提供的固定比全内技术更稳定。在缝合方法中，垂直缝合在循环试验中增宽幅度较小且破坏载荷较大，显示出比水平缝合更理想的生物力学特性。叠加缝合产生的固定比平行缝合更强。就缝合针数而言，双针缝合的生物力学特性优于单针缝合。
