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Abstract

Background: Meniscal root repair techniques have developed, with trans-osseous repair garnering favour. Various materials have been used for the repair, it is currently not clear which is optimal in terms of repair strength.
Hypothesis: Using 2mm tape for trans-osseous meniscus root repair will give rise to a higher maximum load to failure than a repair made using No.2 suture material.
Study Design: Controlled Laboratory Study
Methods: Part A – 19 porcine knees were used. The posterior root attachment of the medial meniscus was subsequently divided. The tibias were potted and transosseous repair of the medial meniscal posterior root was performed. 10 tibias were randomised to suture repair, 9 for tape. The repair strength was measured with a material test machine.
Part B – 10 further porcine knees were prepared. 5 were randomised to the tape group and 5 to the suture group. All repairs were standardised in their placement to be in the body of the meniscus.
A custom image registration routine was created for co-registering all 29 menisci, which allowed a heat map for failure load versus suture location to be generated.
Results: Part A - Higher load to failure was found for the tape group (Mean = 86.7 N, Range: 55.3 to 136.5 N) compared to the suture group (Mean = 57.2 N, range 13.7 to 143.0 N.)
The mean load to failure for repairs placed in the meniscal body (104 N) was higher than those placed in the root ligament (35 N).
Part B - Mean maximum load at ultimate failure was significantly greater for the TAPE group, 298.5 N (p=0.016, Mann-Whitney U, 95% CI 183.9 N to 413.1 N), compared to that for the SUTURE group, mean = 146.8 N (95% CI 82.4 N to 211.6 N).
The heat map revealed that small variations in suture location were associated with large differences in failure load.
Conclusions: The use of 2mm tape provides higher maximum load to failure than the use of a No.2 suture. The position of the repair in the meniscus is also a highly significant factor in the constructs’ properties.
Clinical Relevance: Gives insight into material and location for optimal repair strength.
Key Terms: Meniscal root repair; suture material; biomechanical testing; repair location
Original languageEnglish
Pages (from-to)924-932
JournalThe American Journal of Sports Medicine
Volume46
Issue number4
Early online date24 Jan 2018
DOIs
Publication statusPublished - 1 Mar 2018

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Sutures
Tibia
Knee
Swine
Hot Temperature
Tibial Meniscus
Meniscus
Ligaments

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Transosseous meniscus root repair strength is dependent upon suture position and material. / Robinson, James; Frank, Evelyn; Hunter, Alan J.; Jermin, Paul; Gill, Harinderjit.

In: The American Journal of Sports Medicine, Vol. 46, No. 4, 01.03.2018, p. 924-932.

Research output: Contribution to journalArticle

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title = "Transosseous meniscus root repair strength is dependent upon suture position and material",
abstract = "Background: Meniscal root repair techniques have developed, with trans-osseous repair garnering favour. Various materials have been used for the repair, it is currently not clear which is optimal in terms of repair strength.Hypothesis: Using 2mm tape for trans-osseous meniscus root repair will give rise to a higher maximum load to failure than a repair made using No.2 suture material.Study Design: Controlled Laboratory StudyMethods: Part A – 19 porcine knees were used. The posterior root attachment of the medial meniscus was subsequently divided. The tibias were potted and transosseous repair of the medial meniscal posterior root was performed. 10 tibias were randomised to suture repair, 9 for tape. The repair strength was measured with a material test machine. Part B – 10 further porcine knees were prepared. 5 were randomised to the tape group and 5 to the suture group. All repairs were standardised in their placement to be in the body of the meniscus.A custom image registration routine was created for co-registering all 29 menisci, which allowed a heat map for failure load versus suture location to be generated. Results: Part A - Higher load to failure was found for the tape group (Mean = 86.7 N, Range: 55.3 to 136.5 N) compared to the suture group (Mean = 57.2 N, range 13.7 to 143.0 N.) The mean load to failure for repairs placed in the meniscal body (104 N) was higher than those placed in the root ligament (35 N).Part B - Mean maximum load at ultimate failure was significantly greater for the TAPE group, 298.5 N (p=0.016, Mann-Whitney U, 95{\%} CI 183.9 N to 413.1 N), compared to that for the SUTURE group, mean = 146.8 N (95{\%} CI 82.4 N to 211.6 N). The heat map revealed that small variations in suture location were associated with large differences in failure load.Conclusions: The use of 2mm tape provides higher maximum load to failure than the use of a No.2 suture. The position of the repair in the meniscus is also a highly significant factor in the constructs’ properties. Clinical Relevance: Gives insight into material and location for optimal repair strength.Key Terms: Meniscal root repair; suture material; biomechanical testing; repair location",
author = "James Robinson and Evelyn Frank and Hunter, {Alan J.} and Paul Jermin and Harinderjit Gill",
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T1 - Transosseous meniscus root repair strength is dependent upon suture position and material

AU - Robinson, James

AU - Frank, Evelyn

AU - Hunter, Alan J.

AU - Jermin, Paul

AU - Gill, Harinderjit

PY - 2018/3/1

Y1 - 2018/3/1

N2 - Background: Meniscal root repair techniques have developed, with trans-osseous repair garnering favour. Various materials have been used for the repair, it is currently not clear which is optimal in terms of repair strength.Hypothesis: Using 2mm tape for trans-osseous meniscus root repair will give rise to a higher maximum load to failure than a repair made using No.2 suture material.Study Design: Controlled Laboratory StudyMethods: Part A – 19 porcine knees were used. The posterior root attachment of the medial meniscus was subsequently divided. The tibias were potted and transosseous repair of the medial meniscal posterior root was performed. 10 tibias were randomised to suture repair, 9 for tape. The repair strength was measured with a material test machine. Part B – 10 further porcine knees were prepared. 5 were randomised to the tape group and 5 to the suture group. All repairs were standardised in their placement to be in the body of the meniscus.A custom image registration routine was created for co-registering all 29 menisci, which allowed a heat map for failure load versus suture location to be generated. Results: Part A - Higher load to failure was found for the tape group (Mean = 86.7 N, Range: 55.3 to 136.5 N) compared to the suture group (Mean = 57.2 N, range 13.7 to 143.0 N.) The mean load to failure for repairs placed in the meniscal body (104 N) was higher than those placed in the root ligament (35 N).Part B - Mean maximum load at ultimate failure was significantly greater for the TAPE group, 298.5 N (p=0.016, Mann-Whitney U, 95% CI 183.9 N to 413.1 N), compared to that for the SUTURE group, mean = 146.8 N (95% CI 82.4 N to 211.6 N). The heat map revealed that small variations in suture location were associated with large differences in failure load.Conclusions: The use of 2mm tape provides higher maximum load to failure than the use of a No.2 suture. The position of the repair in the meniscus is also a highly significant factor in the constructs’ properties. Clinical Relevance: Gives insight into material and location for optimal repair strength.Key Terms: Meniscal root repair; suture material; biomechanical testing; repair location

AB - Background: Meniscal root repair techniques have developed, with trans-osseous repair garnering favour. Various materials have been used for the repair, it is currently not clear which is optimal in terms of repair strength.Hypothesis: Using 2mm tape for trans-osseous meniscus root repair will give rise to a higher maximum load to failure than a repair made using No.2 suture material.Study Design: Controlled Laboratory StudyMethods: Part A – 19 porcine knees were used. The posterior root attachment of the medial meniscus was subsequently divided. The tibias were potted and transosseous repair of the medial meniscal posterior root was performed. 10 tibias were randomised to suture repair, 9 for tape. The repair strength was measured with a material test machine. Part B – 10 further porcine knees were prepared. 5 were randomised to the tape group and 5 to the suture group. All repairs were standardised in their placement to be in the body of the meniscus.A custom image registration routine was created for co-registering all 29 menisci, which allowed a heat map for failure load versus suture location to be generated. Results: Part A - Higher load to failure was found for the tape group (Mean = 86.7 N, Range: 55.3 to 136.5 N) compared to the suture group (Mean = 57.2 N, range 13.7 to 143.0 N.) The mean load to failure for repairs placed in the meniscal body (104 N) was higher than those placed in the root ligament (35 N).Part B - Mean maximum load at ultimate failure was significantly greater for the TAPE group, 298.5 N (p=0.016, Mann-Whitney U, 95% CI 183.9 N to 413.1 N), compared to that for the SUTURE group, mean = 146.8 N (95% CI 82.4 N to 211.6 N). The heat map revealed that small variations in suture location were associated with large differences in failure load.Conclusions: The use of 2mm tape provides higher maximum load to failure than the use of a No.2 suture. The position of the repair in the meniscus is also a highly significant factor in the constructs’ properties. Clinical Relevance: Gives insight into material and location for optimal repair strength.Key Terms: Meniscal root repair; suture material; biomechanical testing; repair location

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DO - 10.1177/0363546517749807

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