Saengpetch Nadhaporn, Prasitmeeboon Napat, Janyawongchot Tanapol, Aroonjarattham Panya, Somtua Chompunut, Thamyongkit Sorawut
Department of Orthopaedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Department of Mechanical Engineering, Faculty of Engineering, Mahidol University, Nakornpathom, Thailand.
Orthop J Sports Med. 2024 Oct 8;12(10):23259671241279847. doi: 10.1177/23259671241279847. eCollection 2024 Oct.
Posterior medial meniscus root (PMMR) tears (PMMRTs) can be repaired using various techniques to promote healing. However, the biomechanical properties of suture-relay all-suture anchor (ASA) versus conventional suture anchor (CSA) and loop-locking transtibial pullout (TTP) have not been well established.
To compare the biomechanical properties of PMMR repairs using suture-relay ASA, CSA, and loop-locking TTP.
Controlled laboratory study.
A total of 33 fresh-frozen porcine knee joints with intact medial menisci were randomly divided into 3 groups, with 11 specimens in each group: ASA, CSA, and TTP. The study involved cyclic loading, with displacement measurements taken after 100, 500, and 1000 cycles. Subsequently, the specimens were loaded until clinical failure (defined as 3-mm displacement) and then to ultimate failure of the construct, with data recorded for displacement after cyclic loading, load to 3-mm displacement, and ultimate load to failure.
After 1000 cyclic loadings, the suture-relay ASA group showed considerably less displacement than the loop-locking TTP group (1.8 ± 0.7 mm vs 2.9 ± 0.3 mm; < .001), but the displacements did not differ considerably between the suture-relay ASA and CSA groups (2.2 ± 0.9 mm; > .05). The mean loads to clinical failure were significantly greater in the suture-relay ASA and CSA groups (61.3 ± 6.5 and 57.5 ± 9.7 N, respectively) than in the loop-locking TTP group (38.3 ± 9.4 N; < .05). The ultimate load to failure was significantly greater in the suture-relay ASA group than in the loop-locking TTP group (153 ± 55.1 N vs 102 ± 12.9 N; < .05). All specimens in the loop-locking TTP group failed by suture elongation mode, whereas only 2 specimens (18%) in the suture-relay ASA group and 5 specimens (45%) in the CSA group failed by suture elongation. Nine specimens (82%) in the suture-relay ASA group and 6 specimens (55%) in the CSA group failed due to suture cutout through the meniscal tissue.
The biomechanical properties after PMMR repair did not statistically differ between the suture-relay ASA and CSA groups. The suture-relay ASA technique had a higher load to failure than the loop-locking TTP technique.
The suture-relay ASA technique is a promising option for the repair of PMMRTs; its repairing strength is also comparable to that of the CSA technique. Notably, the suture-relay ASA technique can be utilized without establishing a posteromedial portal, resulting in decreased procedure time and mitigating challenges associated with working from the posterior aspect of the knee.
后内侧半月板根部（PMMR）撕裂（PMMRTs）可采用多种技术进行修复以促进愈合。然而，缝线转接全缝线锚钉（ASA）与传统缝线锚钉（CSA）以及袢锁经胫骨拉出（TTP）的生物力学特性尚未完全明确。
比较使用缝线转接ASA、CSA和袢锁TTP进行PMMR修复的生物力学特性。
对照实验室研究。
总共33个内侧半月板完整的新鲜冷冻猪膝关节被随机分为3组，每组11个标本：ASA组、CSA组和TTP组。该研究包括循环加载，在100、500和1000次循环后进行位移测量。随后，对标本加载直至临床失败（定义为3毫米位移），然后加载至结构的最终失败，记录循环加载后的位移、达到3毫米位移的载荷以及最终失败载荷的数据。
在1000次循环加载后，缝线转接ASA组的位移明显小于袢锁TTP组（1.8±0.7毫米对2.9±0.3毫米；P<.001），但缝线转接ASA组和CSA组之间的位移差异不显著（2.2±0.9毫米；P>.05）。缝线转接ASA组和CSA组达到临床失败的平均载荷显著高于袢锁TTP组（分别为61.3±6.5牛和57.5±9.7牛）（38.3±9.4牛；P<.05）。缝线转接ASA组的最终失败载荷显著高于袢锁TTP组（153±55.1牛对102±12.9牛；P<.05）。袢锁TTP组的所有标本均通过缝线伸长模式失败，而缝线转接ASA组只有2个标本（18%）和CSA组只有5个标本（45%）通过缝线伸长失败。缝线转接ASA组的9个标本（82%）和CSA组的6个标本（55%）因缝线穿出半月板组织而失败。
缝线转接ASA组和CSA组在PMMR修复后的生物力学特性在统计学上没有差异。缝线转接ASA技术比袢锁TTP技术具有更高的失败载荷。
缝线转接ASA技术是修复PMMRTs的一个有前景的选择；其修复强度也与CSA技术相当。值得注意的是，缝线转接ASA技术无需建立后内侧入路即可使用，从而减少手术时间并减轻与从膝关节后方操作相关的挑战。
