Repair of Longitudinal Meniscal Tears by Single or Double Vertical Loop Sutures: In vitro Biomechanical Study under Cyclic Loading

AbstractOne of the factors affecting the healing of a meniscus repair is the primary stability of the tear. The purpose of this study is to compare single and double vertical loop (SVL vs. DVL) meniscal suture configurations by measuring elongation under cyclic loading and failure properties under ultimate load. We hypothesized that DVL configuration would have superior biomechanical properties than SVL. Twenty-two intact lateral menisci were harvested from patients who required total knee arthroplasty. A 20-mm longitudinal full-thickness cut was made 3 mm from the peripheral rim to simulate a longitudinal tear. Two groups were formed and group randomization was done according to patient age and gender (SVL group: mean age 68.3 years [range, 58–78 years], five males, six females; DVL group: mean age 67.4 years [range, 59–77 years], six males, five females). Cyclic loading was performed between 5 and 30 N at a frequency of 1 Hz for 500 cycles. Then, the meniscus repair construct was loaded until failure. Statistical analysis was performed using the t-test and the Mann–Whitney's U-test. During the early phases of cyclic loading, three specimens from each group failed because of suture pull out and are excluded from the study. At the end of 500 cycles, there was significantly less displacement in the DVL group than the SVL group (6.13 ± 1.04 vs. 9.3 ± 2.59 mm) (p < 0.05). No significant difference was found between groups regarding ultimate load to failure measurements (p > 0.05). All specimens in SVL and five specimens in DVL groups failed in the form of suture pull out from the meniscus tissue. Longitudinal meniscal tears repaired with DVL configuration had less elongation value under cyclic loading compared with SVL configuration. Because of its superior biomechanical properties, it would be more secure to repair large and instable longitudinal meniscal tears by the DVL technique. This is a level II study.

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Cyclic Testing of Flexible All-Inside Meniscus Suture Anchors: Biomechanical Analysis

The American Journal of Sports Medicine ◽

10.1177/0363546504271204 ◽

2005 ◽

Vol 33 (3) ◽

pp. 388-394 ◽

Cited By ~ 51

Author(s):

Thore Zantop ◽

Ann K. Eggers ◽

Volker Musahl ◽

Andre Weimann ◽

Wolf Petersen

Keyword(s):

Cyclic Loading ◽

Biomechanical Properties ◽

Meniscus Repair ◽

Biomechanical Analysis ◽

Suture Techniques ◽

Suture Anchors ◽

Pull Out ◽

Meniscus Suture ◽

Significant Difference ◽

Pull Out Strength

Background Flexible meniscus repair devices are designed to combine the benefits of rigid all-inside meniscus anchors with the biomechanical properties of sutures. Hypothesis Stiffness and pull-out strength of flexible all-inside suture anchors and conventional sutures under cyclic loading conditions will be comparable. Study Design Controlled laboratory study Methods In 50 fresh frozen bovine menisci, artificial meniscus lesions were repaired with different meniscus fixation techniques: horizontal and vertical FasT-Fix, RapidLoc, and horizontal and vertical 2-0 Ethibond sutures. The specimens were cycled 1000 times between 5 and 20 N and then loaded to failure. Results All devices survived the cyclic loading protocol. There was no significant difference in the displacement between all repair techniques tested (horizontal FasT-Fix, 6.23 mm; vertical FasT-Fix, 5.34 mm; RapidLoc, 6.84 mm; horizontal 2-0 Ethibond, 6.03 mm; vertical 2-0 Ethibond, 5.61 mm (P >. 05). Vertical and horizontal FasT-Fix suture anchors had a significantly higher stiffness and pull-out strength (94.1 N and 80.8 N, respectively) than did horizontal sutures (50.2 N) and RapidLoc devices (30.3 N) (P >. 05). Conclusions In this study, flexible all-inside meniscus anchors (FasT-Fix) had higher pull-out strength than did conventional vertical suture techniques. Biomechanical characteristics of the flexible RapidLoc are comparable to those of horizontal sutures. Clinical Relevance Flexible all-inside meniscus repair devices are an alternative to conventional suture techniques.

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Braided tape is equivalent to modified Mason-Allen multi-strand #2 suture in subscapularis muscle repair: results of a biomechanical study

Shoulder & Elbow ◽

10.1177/1758573216679945 ◽

2016 ◽

Vol 9 (2) ◽

pp. 85-91

Author(s):

Benjamin Léger-St-Jean ◽

Jérémie Ménard ◽

Stéphanie Hinse ◽

Frédéric Balg ◽

Dominique M Rouleau

Keyword(s):

Cyclic Loading ◽

Ultimate Load ◽

Tendon Repair ◽

Biomechanical Study ◽

Fixation Method ◽

Subscapularis Tendon ◽

Mineral Density ◽

Significant Difference ◽

Load To Failure ◽

The Mean

Background To help determine the optimal fixation method for subscapularis tendon repair in arthroplasty, the present study compares single-passage transosseous tape (BT) and modified Mason-Allen #2 suture (MA). Methods Eighteen human cadaveric shoulders were randomized to two repair constructs after arthroplasty preparation. Both techniques included two transosseous passages through the bicipital groove and then through the tendon at the level of the anatomical neck. Construct was tested using a traction machine, measuring cyclic loading and ultimate load to failure. Results The mean age of our specimens was 71 years. No significant difference was observed between the repair techniques in both mean ultimate load and cyclic loading. The mean (SD) ultimate load (UL) for BT was 293 (84) N and 342 (117) N for MA, which was not statistically significant ( p = 0.374). The majority of repairs failed in the tendon. Bone cut-out was observed with the MA but not for the BT repair. No correlation was found between bone density and UL for BT ( r = −0.09) but there was strong correlation for MA ( r = 0.63). Conclusions The MA repair appears to be more dependant on bone mineral density for ultimate load, indicating that braided-tape might be better suited for osteoporotic patients to avoid bone cut-out.

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A COMPARATIVE BIOMECHANICAL STUDY OF THE LOOPED SQUARE SLIP KNOT AND THE SIMPLE SURGICAL KNOT

Hand Surgery ◽

10.1142/s0218810406003152 ◽

2006 ◽

Vol 11 (01n02) ◽

pp. 93-99 ◽

Cited By ~ 1

Author(s):

Surut Jianmongkol ◽

Geoffrey Hooper ◽

Weerachai Kowsuwon ◽

Tala Thammaroj

Keyword(s):

Ultimate Strength ◽

Hand Surgery ◽

Biomechanical Properties ◽

Biomechanical Study ◽

Skin Closure ◽

Significant Difference ◽

Mode Of Failure ◽

Repetitive Loading ◽

Slip Knot

The looped square slip knot was introduced as a technique for skin closure to avoid the use of sharp instruments in suture removal after hand surgery. We compared the biomechanical properties of this knot with the simple surgical square knot. The ultimate strength of the looped square slip knot was significantly (p = 0.015) higher than the simple surgical knot. There was no significant difference between the two knots in mode of failure. Knot slippage or suture breakage did not occur in any samples when testing security by repetitive loading. Therefore, the looped square slip knot is a safe and convenient alternative to the two-throw surgical knot for use in hand surgery.

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Comparison of a multifilament stainless steel suture with FiberWire for flexor tendon repairs — an in vitro biomechanical study

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193412452074 ◽

2012 ◽

Vol 38 (4) ◽

pp. 418-423 ◽

Cited By ~ 14

Author(s):

E. McDonald ◽

J. A. Gordon ◽

J. M. Buckley ◽

L. Gordon

Keyword(s):

Mechanical Properties ◽

Stainless Steel ◽

Ultimate Load ◽

Flexor Tendon ◽

Biomechanical Study ◽

Flexor Digitorum Profundus ◽

Human Cadaver ◽

Mode Of Failure ◽

Flexor Digitorum

Our goal was to investigate and compare the mechanical properties of multifilament stainless steel suture (MFSS) and polyethylene multi-filament core FiberWire in flexor tendon repairs. Flexor digitorum profundus tendons were repaired in human cadaver hands with either a 4-strand cruciate cross-lock repair or 6-strand modified Savage repair using 4-0 and 3-0 multifilament stainless steel or FiberWire. The multifilament stainless steel repairs were as strong as those performed with FiberWire in terms of ultimate load and load at 2 mm gap. This study suggests that MFSS provides as strong a repair as FiberWire. The mode of failure of the MFSS occurred by the suture pulling through the tendon, which suggests an advantage in terms of suture strength.

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Biomechanical Properties Under Cyclic Loading of Seven Meniscus Repair Techniques

Clinical Orthopaedics and Related Research ◽

10.1097/00003086-200207000-00029 ◽

2002 ◽

Vol 400 ◽

pp. 236-245 ◽

Cited By ~ 42

Author(s):

Roland Becker ◽

Christian St??rke ◽

Marlen Heymann ◽

Wolfgang Nebelung

Keyword(s):

Cyclic Loading ◽

Biomechanical Properties ◽

Meniscus Repair ◽

Repair Techniques

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COMPARISON OF PROXIMAL IN VITRO TOOTH CONTACTS IN CLASS II RESTORATIONS WITH DIFFERENT RESTORATIVE MATERIALS AND CAVITY SIZES USING A NEW MEASUREMENT DEVICE

Journal of Mechanics in Medicine and Biology ◽

10.1142/s0219519415500578 ◽

2015 ◽

Vol 15 (04) ◽

pp. 1550057

Author(s):

WEN-JEN CHANG ◽

YEN-HSIANG CHANG ◽

HSUAN WANG ◽

CHUN-LI LIN

Keyword(s):

Resin Composite ◽

Class Ii ◽

Cavity Size ◽

Measurement Device ◽

Dental Floss ◽

Pull Out ◽

Amalgam Restoration ◽

Significant Difference ◽

Composite Restoration

This study used a newly developed proximal contact strength (PCS) device to evaluate the tightness of proximal tooth contact for Class II cavity size restoration with different materials using an auxiliary separation ring system. A measurement device based on the equilibrium of forces acted on the clamp rod converts a pull-out force between interdental spaces on a force sensing resistor to express the PCS. This device was designed using dental floss as the test end and can be moved with constant speed during measurement through a bevel gear that transforms the rotation of motor shaft into linear movement of clamp rod. A manikin model was used with 60 artificial first molars in which an mesial occlusal (MO) preparation was ground. Samples were divided into six groups (each n = 10) for simulating amalgam and resin composite restoration with three different cavity sizes. The different cavities were defined using the ratio of the actual isthmus width to the intercuspal width (W) to 1/3, 2/3 and 1. The PCS value in each sample was measured after restoration. The result showed that the mean PCS value and standard deviation were 2283.1 ± 216.5 gf, 2419.1 ± 375 gf and 1737.6 ± 372.7 g for 1/3 W, 2/3 W and W cavities of the amalgam restoration, respectively. The corresponding PCS values were 1178.0 ± 230.4 gf, 1205.8 ± 249.1 gf and 1247.0 ± 157.5 gf for 1/3 W, 2/3 W and W cavities of the resin composite restoration. PCS values with amalgam restoration were larger than those for resin composite restorations under the same cavity size. Large cavity (W) PCS might be lost with amalgam restoration. No significant difference was found in resin composite restoration PCS among the different cavity sizes.

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A Novel Fixation System for Acetabular Quadrilateral Plate Fracture: A Comparative Biomechanical Study

BioMed Research International ◽

10.1155/2015/391032 ◽

2015 ◽

Vol 2015 ◽

pp. 1-8 ◽

Cited By ~ 5

Author(s):

Guo-Chun Zha ◽

Jun-Ying Sun ◽

Sheng-Jie Dong ◽

Wen Zhang ◽

Zong-Ping Luo

Keyword(s):

Plate Fixation ◽

Biomechanical Properties ◽

Biomechanical Study ◽

Pelvic Brim ◽

Quadrilateral Plate ◽

Plate Fracture ◽

Fixation Techniques ◽

Biomechanical Experiment ◽

Fixation System

This study aims to assess the biomechanical properties of a novel fixation system (named AFRIF) and to compare it with other five different fixation techniques for quadrilateral plate fractures. This in vitro biomechanical experiment has shown that the multidirectional titanium fixation (MTF) and pelvic brim long screws fixation (PBSF) provided the strongest fixation for quadrilateral plate fracture; the better biomechanical performance of the AFRIF compared with the T-shaped plate fixation (TPF), L-shaped plate fixation (LPF), and H-shaped plate fixation (HPF); AFRIF gives reasonable stability of treatment for quadrilateral plate fracture and may offer a better solution for comminuted quadrilateral plate fractures or free floating medial wall fracture and be reliable in preventing protrusion of femoral head.

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Biomechanical properties of expander compared with conventional screws

Journal of Neurosurgery Spine ◽

10.3171/spi.2002.97.3.0346 ◽

2002 ◽

Vol 97 (3) ◽

pp. 346-349 ◽

Cited By ~ 1

Author(s):

Aziz Rassi-Neto ◽

Antonio Shimano

Keyword(s):

Maximum Load ◽

Biomechanical Properties ◽

Biomechanical Study ◽

Intergroup Difference ◽

Content Type ◽

Significant Difference ◽

Group 2 ◽

The Comparative Study ◽

Screw Group ◽

Fine Print

Object. A pullout strength biomechanical study was performed in 20 fresh swine vertebral bodies in which titanium expander (Group 1) and conventional screws (Group 2) were placed. Methods. The screws were inserted into the anterosuperior portion of the anterior spine, and assessment was performed after application of loads. The expander screw is composed of two parts: 1) a cover with an external portion comprising tight thin threads; and 2) a compact internal screw inserted through the cover that allows expansion. In the comparative study between the screws in Groups 1 and 2 maximum load was assessed, and the intergroup difference was significant (p = 0.00001 [t-test]); regarding load at the elasticity threshold, a significant difference was also observed (p = 0.0063). With regard to rigidity (stiffness), there was a tendency in both groups toward significance (p = 0.069). With regard to absorbed energy in the elastic phase, statistical analysis showed a significant intergroup difference (p = 0.00439). The expander screw showed a greater load-bearing capacity than the conventional screw. Adhesion to bone in relation to the applied load and displacement was greater (significant tendency) in the expander screw group than in the conventional screw group. Conclusions. The expander screws exhibited a greater capacity to absorb energy in the elastic phase. They adhered better to bone, were easy to insert, and, if necessary, were simple to remove.

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Biomechanical Evaluation of Minimally Invasive Repairs for Complete Acromioclavicular Joint Dislocation

The American Journal of Sports Medicine ◽

10.1177/0363546506298585 ◽

2007 ◽

Vol 35 (6) ◽

pp. 955-961 ◽

Cited By ~ 45

Author(s):

Mathias Wellmann ◽

Thore Zantop ◽

Andre Weimann ◽

Michael J. Raschke ◽

Wolf Petersen

Keyword(s):

Minimally Invasive ◽

Ultimate Load ◽

Suture Anchor ◽

Biomechanical Properties ◽

Fixation Strength ◽

Acromioclavicular Joint Dislocation ◽

Coracoclavicular Ligament ◽

Invasive Approach ◽

Significant Difference ◽

Permanent Elongation

Background The conventional coracoclavicular ligament augmentation with a single polydioxanone loop has been shown to have some pivotal disadvantages. Hypothesis A minimally invasive flip button/polydioxanone repair provides similar biomechanical properties to the conventional polydioxanone cerclage around the coracoid. However, the authors expected a difference in linear stiffness, ultimate load, and permanent elongation between suture anchor repairs and polydioxanone repairs. Study Design Controlled laboratory study. Methods The tensile fixation strength of 4 different minimally invasive repairs was tested in a porcine metatarsal model: (1) 1.3-mm single polydioxanone cerclage with a subcoracoidal flip button fixation, (2) 1.3-mm single polydioxanone cerclage, (3) Twinfix Ti 3.5-mm/Ultrabraid 2-suture anchor, and (4) Twinfix Ti 5.0-mm/Ultrabraid 2-suture anchor. The testing protocol included cyclic superoinferior loading and a subsequent load to failure trial. Results The flip button repair (646 N) and the conventional polydioxanone banding (663 N) revealed significant higher ultimate loads than did the suture anchor repairs (295 and 331 N, respectively; P < .001), whereas no significant differences were found for the elongation behavior under cyclic loading. Conclusion There was no significant difference between the 2 polydioxanone repairs. The ultimate load of the flip button procedure reaches the level of the native coracoclavicular ligament complex as it has been quantified in the literature. Clinical Relevance Although the biomechanical results comparing a minimally invasive flip button procedure versus a conventional polydioxanone cerclage are similar, the authors recommend the flip button procedure because of its minimally invasive approach and the secure subcoracoidal fixation technique with a minimized risk of anterior loop dislocation and neurovascular damage.

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