Biomechanical comparison of meniscus-suture constructs for pullout repair of medial meniscus posterior root tears

BACKGROUND: Transtibial pullout repair for posterior meniscus root tear is widely performed to restore meniscal function. However, it is sometimes technically difficult to pass the suture through the posterior medial meniscus root in narrow joint space. To address this limitation, a new suture technique using an all-inside meniscal suture device through the tibial tunnel was proposed. The purpose of the present study was to compare the biomechanical properties of a meniscus-suture construct prepared using an all-inside meniscal suture device and those of the construct prepared using conventional suture techniques. METHODS: A total of 18 fresh-frozen porcine medial menisci were used and randomly divided into three groups according to the type of suturing technique applied. Three suturing methods were evaluated: suturing with all-inside meniscal suture device, single simple suture, and double simple sutures. All specimens were subjected to cyclic loading of 300 cycles followed by a load-to-failure test. The displacement after cyclic loading, the ultimate failure load, and the mode of failure were evaluated. RESULTS: There was no significant difference among the three suturing techniques regarding both displacement after cyclic loading and ultimate failure load. Suture breakage was the most common failure mode in each group. CONCLUSIONS: The biomechanical properties of meniscus-suture construct with the all-inside meniscal suture device were equivalent to those obtained using conventional suture techniques. Our results suggest that pullout repair using the all-inside meniscal suture device through the tibial tunnel could serve as an alternative suture technique for the repair of posterior meniscus root tears.