Steadman Philippon Research Institute, Vail, Colorado, USA.
Departament of Orthopedics and Traumatology, Universidade Federal de São Paulo, São Paulo, Brazil.
Am J Sports Med. 2019 Apr;47(5):1194-1202. doi: 10.1177/0363546519830402. Epub 2019 Mar 21.
Given the variety of suturing techniques for bucket-handle meniscal repair, it is important to assess which suturing technique best restores native biomechanics.
PURPOSE/HYPOTHESIS: To biomechanically compare vertical mattress and cross-stitch suture techniques, in single- and double-row configurations, in their ability to restore native knee kinematics in a bucket-handle medial meniscal tear model. The hypothesis was that there would be no difference between the vertical mattress and cross-stitch double-row suture techniques but that the double-row technique would provide significantly improved biomechanical parameters versus the single-row technique.
Controlled laboratory study.
Ten matched pairs of human cadaver knees were randomly assigned to the vertical mattress (n = 10) or cross-stitch (n = 10) repair group. Each knee underwent 4 consecutive testing conditions: (1) intact, (2) displaced bucket-handle tear, (3) single-row suture configuration on the femoral meniscus surface, and (4) double-row suture configuration (repair of femoral and tibial meniscus surfaces). Knees were loaded with a 1000-N axial compressive force at 0°, 30°, 60°, 90°, and 120° of flexion for each condition. Resultant medial compartment contact area, average contact pressure, and peak contact pressure data were recorded.
Intact state contact area was not restored at 0° ( P = .027) for the vertical double-row configuration and at 0° ( P = .032), 60° ( P < .001), and 90° ( P = .007) of flexion for the cross-stitch double-row configuration. No significant differences were found in the average contact pressure and peak contact pressure between the intact state and the vertical mattress and cross-stitch repairs with single- and double-row configurations at any flexion angles. When the vertical and cross-stich repairs were compared across all flexion angles, no significant differences were observed in single-row configurations, but in double-row configurations, cross-stitch repair resulted in a significantly decreased contact area, average contact pressure, and peak contact pressure (all P < .001).
Single- and double-row configurations of the vertical mattress and cross-stitch inside-out meniscal repair techniques restored native tibiofemoral pressure after a medial meniscal bucket-handle tear at all assessed knee flexion angles. Despite decreased contact area with a double-row configuration, mainly related to the cross-stitch repair, in comparison with the intact state, the cross-stitch double-row repair led to decreased pressure as compared with the vertical double-row repair. These findings are applicable only at the time of the surgery, as the biological effects of healing were not considered.
Medial meniscal bucket-handle tears may be repaired with the single- or double-row configuration of vertical mattress or cross-stitch sutures.
鉴于半月板桶柄样撕裂的缝合技术种类繁多，评估哪种缝合技术最能恢复原生生物力学就显得尤为重要。
目的/假设：本研究旨在对垂直褥式和十字交叉缝合技术进行生物力学比较，分别在单排和双排配置下，评估其在模拟内侧半月板桶柄样撕裂模型中恢复原生膝关节运动学的能力。假设是垂直褥式和十字交叉双排缝合技术之间没有差异，但与单排技术相比，双排技术将提供显著改善的生物力学参数。
对照实验室研究。
10 对配对的人尸体膝关节随机分为垂直褥式（n=10）或十字交叉（n=10）修复组。每个膝关节进行 4 种连续测试条件：（1）完整，（2）半月板桶柄样撕裂移位，（3）股骨半月板表面的单排缝线配置，（4）双排缝线配置（修复股骨和胫骨半月板表面）。膝关节在 0°、30°、60°、90°和 120°的屈曲位时，施加 1000N 的轴向压缩力。记录内侧间室接触面积、平均接触压力和峰值接触压力数据。
在 0°时，垂直褥式双排配置的完整状态接触面积无法恢复（P=0.027），而十字交叉双排配置在 0°（P=0.032）、60°（P<0.001）和 90°（P=0.007）的屈曲位也无法恢复。在任何屈曲角度下，垂直褥式和十字交叉褥式的单排和双排缝线修复的平均接触压力和峰值接触压力与完整状态之间均无显著差异。当将垂直和十字交叉修复在所有屈曲角度上进行比较时，在单排配置中没有观察到显著差异，但在双排配置中，十字交叉修复导致接触面积、平均接触压力和峰值接触压力显著降低（均 P<0.001）。
内侧半月板桶柄样撕裂后，垂直褥式和十字交叉内固定半月板修复技术的单排和双排缝线配置在所有评估的膝关节屈曲角度都能恢复正常的胫股压力。尽管与完整状态相比，双排配置中十字交叉修复的接触面积减小，但与垂直褥式双排修复相比，十字交叉双排修复导致的压力降低。这些发现仅适用于手术时，因为未考虑愈合的生物学效应。
内侧半月板桶柄样撕裂可以采用垂直褥式或十字交叉缝线的单排或双排配置进行修复。
