College of Medicine, The Ohio State University, Columbus, Ohio, U.S.A.
Department of Orthopaedics, Wexner Medical Center, The Ohio State University, Columbus, Ohio, U.S.A.
Arthroscopy. 2019 Jul;35(7):2189-2206.e2. doi: 10.1016/j.arthro.2019.01.018. Epub 2019 Apr 9.
To systematically review the literature regarding the biomechanical properties of various meniscal root repair techniques.
A systematic review of multiple databases was performed. The inclusion criteria included English language, studies relevant to meniscal root repairs, studies comparing 2 or more different discrete techniques, posterior root repairs, controlled laboratory studies, and human cadaveric or animal studies. Abstracts, case reports, cohort studies, case-control studies, systematic reviews and meta-analyses, and studies of meniscal body repairs were excluded.
Seventeen controlled laboratory studies were included for final analysis. There is no consensus on biomechanical superiority between transtibial pullout repair (TPR) and suture anchor repair. For TPR, there is no significant difference between 1 and 2 tibial tunnels. Nonanatomic repairs result in significantly lower joint surface contact areas and higher contact pressures, but suture placement farther from the root results in higher maximum load to failure. Two-suture repair has a greater maximum load to failure than 1-suture repair. Use of more than 2 sutures has diminishing returns. The modified Mason-Allen suture configuration is superior to a simple suture configuration, but there is no consensus regarding the superiority or feasibility of more complex sutures. There is no consensus on the superiority of a single suture material or shape.
Anatomic meniscal root repairs with either TPR or suture anchor repair have better joint surface contact pressures and contact surface areas than nonanatomic repairs. The use of 2 sutures results in better fixation than 1 suture. There is evidence that the modified Mason-Allen suture configuration is superior to a simple suture configuration in a TPR, although the benefits of more complicated configurations are unclear.
This study suggests that, in general, more complex sutures exhibit higher maximum loads. Increasing the number of sutures to up to 2 of the same configuration also increases the maximum load.
系统回顾有关各种半月板根部修复技术生物力学特性的文献。
对多个数据库进行了系统回顾。纳入标准包括英语、与半月板根部修复相关的研究、比较两种或两种以上不同离散技术的研究、后根修复、对照实验室研究以及人体尸体或动物研究。排除摘要、病例报告、队列研究、病例对照研究、系统评价和荟萃分析以及半月板体修复的研究。
最终分析纳入了 17 项对照实验室研究。在经胫骨隧道拉拔修复（TPR）和缝合锚修复之间，没有关于生物力学优越性的共识。对于 TPR，1 个和 2 个胫骨隧道之间没有显著差异。非解剖修复导致关节表面接触面积显著减小和接触压力显著增加，但缝线位置离根部越远，失效时的最大负荷越高。双缝线修复的失效时最大负荷大于单缝线修复。使用超过 2 根缝线的效果逐渐降低。改良的 Mason-Allen 缝线构型优于简单缝线构型，但对于更复杂的缝线，哪种更优越或更可行尚无共识。对于单根缝线材料或形状的优越性也没有共识。
与非解剖修复相比，采用 TPR 或缝合锚修复的解剖半月板根部修复具有更好的关节表面接触压力和接触面积。使用 2 根缝线比使用 1 根缝线的固定效果更好。有证据表明，改良的 Mason-Allen 缝线构型在 TPR 中优于简单缝线构型，尽管更复杂构型的优势尚不清楚。
本研究表明，一般来说，更复杂的缝线表现出更高的最大负荷。增加缝线数量至最多 2 根相同构型也会增加最大负荷。
