Briese Thorben, Kieninger Amaris, Peez Christian, Deichsel Adrian, Herbst Elmar, Balke Maurice, Raschke Michael J, Kittl Christoph
Department of Trauma, Hand- and Reconstructive Surgery University Hospital Münster Münster Germany.
Sportsclinic Cologne Cologne Germany.
J Exp Orthop. 2025 Jun 15;12(2):e70310. doi: 10.1002/jeo2.70310. eCollection 2025 Apr.
Repair techniques for posterior meniscal root (PMMR) tears include repair with transtibial pull-out and anchors. An alternative approach uses all-suture anchors pulled in, avoiding a posterior medial portal. While clinical feasibility has been assessed, biomechanical properties of this technique remain unknown. We hypothesised that the biomechanical properties using the pull-in technique would be comparable to those achieved with conventional repair techniques.
Fifty fresh-frozen porcine tibiae were fixed in a steel pot. Whereas in group (1) the native meniscal root was kept intact (native meniscal root (NM)), the PMMR was sectioned and refixed in groups (2)-(5): (2) Double-loaded suture anchor (screw anchor) (SA), (3) transtibial pull-out repair with two sutures (TTPO), (4) double-loaded pull-in repair with all-suture anchor that was pulled into the subcortical bone which was predrilled from retrograde direction (PULL) and (5) double-loaded push-in repair with all-suture anchor traditionally pushed into the predrilled subcortical bone in antegrade direction (PUSH). Testing was performed using a universal testing machine with 1000 cycles (5-20 N/0.5 Hz) with subsequent load-to-failure (LTF) meaning failure of the NM or refixation. Outcomes measured included LTF (N), cyclic displacement (mm), and stiffness (N/mm). The failure mode was documented macroscopically.
Controlled laboratory study.
No repair technique restored the stability of the NM, reaching 1064.6 ± 226.0 N in LTF ( ≤ 0.0001). Reconstructions had significantly lower LTF: SA (251.4 ± 52.8 N), TTPO (233.4 ± 50.0 N), PULL (206.2 ± 86.5 N) and PUSH (214.3 ± 55.2 N). The NM showed the highest stiffness with 156.1 ± 76.3 N/mm ( ≤ .0001) compared to (SA) 36.2 ± 10.1 N/mm, (TTPO) 33.6 ± 6.2 N/mm, (PULL) 36.8 ± 12.7 N/mm, (PUSH) 27.7 ± 6.6 N/mm. Increased displacement after 1000 cycles was shown, with (2.3 ± 0.7 mm) in PULL, only with significant differences noted between NM (1.5 ± 0.8 mm) and PUSH (3.1 ± 0.7 mm) ( ≤ .001), NM and SA (2.5 ± 0.8 mm) ( ≤ .05), and TTPO (2.1 ± 0.7 mm) and PUSH ( ≤ .05). No failures occurred during cyclic loading. Failure after LTF was always a suture cut-out at the meniscus.
Current repair techniques for posterior medial root tears do not fully restore the biomechanical properties of an intact root. The new pull-in technique with an all-suture anchor which is pulled in instead of pushed in shows biomechanical properties comparable to conventional methods, especially regarding LTF.
There is no level of evidence as this study was an experimental laboratory study.
后内侧半月板根部（PMMR）撕裂的修复技术包括经胫骨拉出修复和使用锚钉修复。另一种方法是使用拉入式全缝线锚钉，避免后内侧入路。虽然已经评估了该技术的临床可行性，但其生物力学特性仍不清楚。我们假设使用拉入技术的生物力学特性与传统修复技术相当。
将50根新鲜冷冻猪胫骨固定在钢罐中。在第（1）组中，保留天然半月板根部完整（天然半月板根部（NM）），而在第（2） - （5）组中切断并重新固定PMMR：（2）双负荷缝线锚钉（螺钉锚钉）（SA），（3）用两根缝线经胫骨拉出修复（TTPO），（4）使用从逆行方向预钻孔的皮质下骨拉入的全缝线锚钉进行双负荷拉入修复（PULL），以及（5）使用传统上顺行方向推入预钻孔皮质下骨的全缝线锚钉进行双负荷推入修复（PUSH）。使用万能试验机进行测试，进行1000次循环（5 - 20 N/0.5 Hz），随后进行直至失败的负荷（LTF）测试，即NM或重新固定失败。测量的结果包括LTF（N）、循环位移（mm）和刚度（N/mm）。宏观记录失败模式。
对照实验室研究。
没有一种修复技术能恢复NM的稳定性，NM的LTF达到1064.6±226.0 N（P≤0.0001）。重建后的LTF显著降低：SA（251.4±52.8 N）、TTPO（233.4±50.0 N）、PULL（206.2±86.5 N）和PUSH（214.3±55.2 N）。与SA（36.2±10.1 N/mm）、TTPO（33.6±6.2 N/mm）、PULL（36.8±12.7 N/mm）、PUSH（27.7±6.6 N/mm）相比，NM的刚度最高，为156.1±76.3 N/mm（P≤0.0001）。1000次循环后显示位移增加，PULL组为（2.3±0.7 mm），仅在NM（1.5±0.8 mm）与PUSH（3.1±0.7 mm）（P≤0.001）、NM与SA（2.5±0.8 mm）（P≤0.05）以及TTPO（2.1±0.7 mm）与PUSH（P≤0.05）之间存在显著差异。循环加载期间未发生失败。LTF后失败总是半月板处的缝线穿出。
目前后内侧根部撕裂的修复技术不能完全恢复完整根部的生物力学特性。使用拉入而非推入的全缝线锚钉的新拉入技术显示出与传统方法相当的生物力学特性，尤其是在LTF方面。
由于本研究是一项实验性实验室研究，所以不存在证据水平。
