Meniscus Root Repair

Meniscal root tears defined as bony or soft tissue root avulsion injuries or radial tears within 1cm of the meniscal root attachment. If it is not treated properly can cause early development of osteoarthritis. The meniscal root tears leading to compromised hoop stress and decreased tibiofemoral contact area and increased contact pressures in the involved compartment. To confirm the diagnosis is through arthroscopic as a diagnostic and treatment and through magnetic resonance imaging. Not all meniscal root tears can be treated surgically, especially if they have multiple comorbidities or advanced age, severe osteoarthritis, non-symptomatic chronic meniscal root tears and significant mal-alignment of the affected compartment then the treatment of choice is to give a symptomatic treatment like non-steroid anti-inflammatory drug, and activity modification. Meniscectomy has been found to induce a high rate of arthritis progression postoperatively. There are two most common meniscal root repair techniques which are trans-tibial pullout repair and suture anchor repair that now preferred over meniscectomy. The most important thing to consider when repairing the meniscal root is the right anatomically repair. It has been proven that non-anatomical meniscal root repair will not able to restore to the normal function because the conversion of femorotibial loads into circumferential tension may be altered, with functional impairment of the knee. Anchor suture technique shows a greater degree of healing and better biomechanical outcome. The suture anchor technique uses “all-inside" fixation and avoids the need for a distal fixation which potentially places abrasive forces on the sutures used. The trans-tibial pullout repair can restore the attachment and contact pressure near normal value, also the tunnel drilling stimulating growth factors and progenitor cells from bone marrow and facilitate the ability of meniscus to convert axial load into hoop stress. The concern of trans-tibial pullout repair is its ‘bungee effect’ and repetitive loading resulted in the displacement of this repair complex and might compromise healing because of decreased stiffness and micromotion of the meniscus-suture complex.

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The Strength of Transosseous Medial Meniscal Root Repair Using a Simple Suture Technique Is Dependent on Suture Material and Position

The American Journal of Sports Medicine ◽

10.1177/0363546517749807 ◽

2018 ◽

Vol 46 (4) ◽

pp. 924-932 ◽

Cited By ~ 6

Author(s):

James R. Robinson ◽

Evelyn G. Frank ◽

Alan J. Hunter ◽

Paul J. Jermin ◽

Harinderjit S. Gill

Keyword(s):

Medial Meniscus ◽

Failure Load ◽

Suture Technique ◽

Posterior Root ◽

Heat Map ◽

Meniscal Root ◽

Root Repair ◽

Suture Group ◽

The Mean ◽

Tape Group

Background: A simple suture technique in transosseous meniscal root repair can provide equivalent resistance to cyclic load and is less technically demanding to perform compared with more complex suture configurations, yet maximum yield loads are lower. Various suture materials have been investigated for repair, but it is currently not clear which material is optimal in terms of repair strength. Meniscal root anatomy is also complex; consisting of the ligamentous mid-substance (root ligament), the transition zone between the meniscal body and root ligament; the relationship between suture location and maximum failure load has not been investigated in a simulated surgical repair. Hypotheses: (A) Using a knottable, 2-mm-wide, ultra-high-molecular-weight polyethylene (UHMWPE) braided tape for transosseous meniscal root repair with a simple suture technique will give rise to a higher maximum failure load than a repair made using No. 2 UHMWPE standard suture material for simple suture repair. (B) Suture position is an important factor in determining the maximum failure load. Study Design: Controlled laboratory study. Methods: In part A, the posterior root attachment of the medial meniscus was divided in 19 porcine knees. The tibias were potted, and repair of the medial meniscus posterior root was performed. A suture-passing device was used to place 2 simple sutures into the posterior root of the medial meniscus during a repair procedure that closely replicated single-tunnel, transosseous surgical repair commonly used in clinical practice. Ten tibias were randomized to repair with No. 2 suture (Suture group) and 9 tibias to repair with 2-mm-wide knottable braided tape (Tape group). The repair strength was assessed by maximum failure load measured by use of a materials testing machine. Micro–computed tomography (CT) scans were obtained to assess suture positions within the meniscus. The wide range of maximum failure load appeared related to suture position. In part B, 10 additional porcine knees were prepared. Five knees were randomized to the Suture group and 5 to the Tape group. All repairs were standardized for location, and the repair was placed in the body of the meniscus. A custom image registration routine was created to coregister all 29 menisci, which allowed the distribution of maximum failure load versus repair location to be visualized with a heat map. Results: In part A, higher maximum failure load was found for the Tape group (mean, 86.7 N; 95% CI, 63.9-109.6 N) compared with the Suture group (mean, 57.2 N; 95% CI, 30.5-83.9 N). The 3D micro-CT analysis of suture position showed that the mean maximum failure load for repairs placed in the meniscus body (mean, 104 N; 95% CI, 81.2-128.0 N) was higher than for those placed in the root ligament (mean, 35.1 N; 95% CI, 15.7-54.5 N). In part B, the mean maximum failure load was significantly greater for the Tape group, 298.5 N ( P = .016, Mann-Whitney U; 95% CI, 183.9-413.1 N), compared with that for the Suture group, 146.8 N (95% CI, 82.4-211.6 N). Visualization with the heat map revealed that small variations in repair location on the meniscus were associated with large differences in maximum failure load; moving the repair entry point by 3 mm could reduce the failure load by 50%. Conclusion: The use of 2-mm braided tape provided higher maximum failure load than the use of a No. 2 suture. The position of the repair in the meniscus was also a highly significant factor in the properties of the constructs. Clinical Relevance: The results provide insight into material and location for optimal repair strength.

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Knotless Anchor Fixation for Transosseous Meniscal Root Repair Using Suture Tape Is Inferior Compared With Button or Screw Fixation: A Biomechanical Study

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120912185 ◽

2020 ◽

Vol 8 (4) ◽

pp. 232596712091218

Author(s):

James R. Robinson ◽

Bruno Agostinho Hernandez ◽

Clare Taylor ◽

Harinderjit S. Gill

Keyword(s):

Cyclic Loading ◽

Suture Anchor ◽

Suture Anchors ◽

Optimal Method ◽

Tibial Fixation ◽

Meniscal Root ◽

Root Repair ◽

Significant Difference ◽

Suture Anchor Fixation ◽

Anchor Fixation

Background: A 2 mm–wide ultrahigh-molecular-weight polyethylene (UHMWPE) tape improves the contact pressure at root repair sites compared with high-strength suture and provides a stronger repair construct. UHMWPE tape is commonly used in rotator cuff repair, and fixation is often achieved with knotless suture anchors. The optimal method for tape fixation for meniscal root repair has not been established. Hypothesis: The use of suture anchors for the tibial fixation of 2-mm UHMWPE tape transosseous root repairs will lead to better biomechanical performance compared with other fixation methods. Methods: The medial meniscal posterior root attachment in 25 porcine knees was divided, and a standardized transtibial root repair was performed using 2-mm UHMWPE tape. The testing was performed by cyclic loading followed by load to failure. Tibial fixation was randomized to 5 tibial fixation types: (1) cortical fixation button, (2) pound-in suture anchor with screw-down interference suture locking, (3) tap-in suture anchor with inner locking plug, (4) postscrew, and (5) postscrew and washer. Results: There was no difference in displacement during cyclic loading between tibial fixation groups except for a highly significant difference in the maximum load at failure. Repairs in both suture anchor fixation groups all failed by tape slippage at relatively low loads (median, 145 and 116 N, respectively). Repairs tied over a cortical button, postscrew, or screw and washer failed by tape breakage at loads of 431, 405, and 528 N. Conclusion: For meniscal root repairs with 2-mm UHMWPE tape, use of suture anchors offers weaker fixation compared with tying over a button or postscrew/washer. While suture anchor fixation may be adequate for nonweightbearing postoperative protocols, it may not allow for more accelerated weightbearing.

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Medial Meniscal Root Repair Using Curved Guide and Soft Suture Anchor

Clinics in Orthopedic Surgery ◽

10.4055/cios.2018.10.1.111 ◽

2018 ◽

Vol 10 (1) ◽

pp. 111 ◽

Cited By ~ 7

Author(s):

Su-Keon Lee ◽

Bong-Seok Yang ◽

Byeong-Mun Park ◽

Ji-Ung Yeom ◽

Ji-Hyeon Kim ◽

...

Keyword(s):

Suture Anchor ◽

Meniscal Root ◽

Root Repair

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Letter to the Editor on “The distance between the tibial tunnel aperture and meniscal root attachment is correlated with meniscal healing status following transtibial pullout repair for medial meniscus posterior root tear”

The Knee ◽

10.1016/j.knee.2020.12.030 ◽

2021 ◽

Author(s):

Haitao Chen ◽

Liaobin Chen

Keyword(s):

Medial Meniscus ◽

Tibial Tunnel ◽

Posterior Root ◽

Root Tear ◽

Posterior Root Tear ◽

Meniscal Root ◽

Letter To The Editor ◽

Meniscal Healing ◽

Pullout Repair ◽

Root Attachment

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Complications with the Zurich Canine Total Hip Replacement System in an Initial Series of Cases Performed by a Single Surgeon

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0041-1730366 ◽

2021 ◽

Author(s):

Samuel P. Franklin ◽

Nathan A. Miller ◽

Todd Riecks

Keyword(s):

Total Hip Replacement ◽

Hip Replacement ◽

Weight Bearing ◽

Normal Function ◽

High Rate ◽

Total Hip ◽

Initial Series ◽

Major Complications ◽

Hip Replacements ◽

Replacement System

Abstract Objective The aim of this study was to quantify the complications using the Zurich total hip replacement system in an initial series of cases performed by a single surgeon who had experience with other total hip replacement systems. Materials and Methods This was a retrospective study in which complications were classified as major if any treatment was needed or if the outcome was less than near-normal function. Complications that did not warrant treatment and that did not result in function that was inferior to near-normal were considered minor. Outcomes were assessed by radiographic review, physical examination, subjective gait evaluation or, in one case, by objective gait analysis. Bilateral total hip replacements were considered separate procedures. Results The first 21 procedures in 19 dogs performed by a single surgeon were included. The mean time to follow-up was 48 weeks (range: 8–120 weeks; standard deviation: 36 weeks). Two cases (of 21) experienced major complications including one dog with excess internal femoral rotation during weight bearing and one dog having luxation. One case (of 21) had a minor complication; femoral fracture in the presence of an intact bone plate that maintained alignment and healed without treatment. Clinical Significance A high rate of successful outcomes with few major complications can be obtained in the initial cases treated using the Zurich total hip replacement system for surgeons with prior experience with other total hip replacement systems.

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