Medial Meniscal Root Repair Using Curved Guide and Soft Suture Anchor

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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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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