Biomechanical Comparison of the Simple Suture Technique, Meniscal Matrix-Assisted Repair, and a Novel Meniscus Cap Suture Technique for Complex Meniscal Repair

Abstract

Background: Meniscal repair is the gold standard for simple morphology tears. However, when the morphology and chronicity of the tear are less favorable, the success of the standard techniques is reduced. Purpose/Hypothesis: To compare meniscal repair augmented by a new bioresorbable implant (Meniscus Cap) versus a traditional simple suture technique and the currently available augmented repair collagen matrix meniscus wrapping technique. It was hypothesized that the Meniscus Cap suture technique would increase ultimate failure load and less displacement during cyclic loading. Study Design: Controlled laboratory study. Methods: A total of 80 fresh porcine menisci were harvested. Complex tears were created in 60 menisci, and 20 intact menisci were tested as the control group. Repairs were performed on the 60 meniscal tears using 1 of the 3 techniques (20 menisci each): an inside-out H-suture group (SS), the collagen matrix wrapping technique (CMW), and the Meniscus Cap bioresorbable implant group (CM). The menisci were subjected to 500 loading cycles from 4 to 20 N at a frequency of 1 Hz, and the total displacement was recorded. Then, the specimens underwent load to failure testing at a rate of 3.15 mm/s, and the failure mode was noted. Results: After 500 cycles of cyclic loading, there were no significant differences in displacement between the controls and CM group (0.524 vs 0.448 mm; P = .95). The displacement after the CM was significantly smaller compared with the CMW and the SS (0.448 vs 1.077 mm [ P = .0009] and 0.448 vs 0.848 mm [ P = .04], respectively). The ultimate load to failure was significantly greater for the controls and the CM group compared with the SS and CMW groups (controls, 1278.7 N and CM, 628.5 N vs CMW, 380.1 N and SS, 345.1 N; P < .05). The failure mode was suture breakage (suture failure) for all repairs. Conclusion: In a porcine specimen meniscal repair model, the biomechanical properties of a novel Meniscus Cap repair technique were superior to that of the simple suture and CMW techniques. Clinical Relevance: The results suggest that the Meniscal Cap repair technique may provide sufficient primary stability of the meniscal fixation even in the cases of complex meniscal tears.