“Horizontal butterfly” technique in repair of radial meniscus tears: A biomechanical study

Introduction: Radial meniscus tears are seen in young patients, especially with anterior cruciate ligament ruptures. Repair of complete radial meniscus tear is necessary for the meniscus functions. The most important factor for success of the meniscus repair is primary stability, but it is still unknown which technique is ideal repair technique. Aim: We developed a new suture technique named Horizontal Butterfly (HB). In this novel technique the contact between meniscal tissue and suture is more than Horizontal Loop (HL) that routinely used today. So, we think that this technique will provide better fixation than HL. We aimed to compare 2 repair techniques (HB vs. HL) using human lateral menisci biomechanically with cyclic loading and load to failure tests. Material-method: We used 22 intact lateral meniscus obtained from patients that operated (total knee replacement) for varus gonarthrosis in our clinic. All menisci were cut radially. In the first group (n:11) menisci were repaired with standard horizontal loop technique, and in the second group (n:11) horizontal butterfly technique were used for repair. All specimens were tested with load to failure test after cyclic loading test (500 cycle X 5e30 N). Results: Both groups have similar failure load (71,4 ± 17,52 N vs. 77,9 ± 28,49 N; p:0,559) and stiffness (24,46 ± 19,19 N vs. 24,48 ± 15,87 N; p:0,818). HB group has less peak displacement (6,26 ± 1,24 mm vs. 8,4 ± 1,92 mm; p:0,010). Conclusion: This novel repair technique decreases the amount of displacement according to standard technique while as strong as standard technique routinely used. In this way; we believe that it will increase the rate of healing in clinical use.

___

Allen CR, Wong EK, Livesay GA, Sakane M, Fu FH, Woo SL. Importance of the medial meniscus in the anterior cruciate ligament-deficient knee. J Orthop Res. 2000 Jan;18(1):109e115. https://doi.org/10.1002/jor.1100180116.

Allen PR, Denham RA, Swan AV. Late degenerative changes after meniscectomy. Factors affecting the knee after operation. J Bone Joint Surg Br. 1984 Nov;66(5):666e671. https://doi.org/10.1302/0301-620x.66b5.6548755.

Krause WR, Pope MH, Johnson RJ, Wilder DG. Mechanical changes in the knee after meniscectomy. J Bone Joint Surg Am. 1976 Jul;58(5):599e604. https:// doi.org/10.2106/00004623-197658050-00003.

McDermott ID, Amis AA. The consequences of meniscectomy. J Bone Joint Surg Br. 2006 Dec;88(12):1549e1556. https://doi.org/10.1302/0301-620X.88B12.18140.

Meakin JR, Shrive NG, Frank CB, Hart DA. Finite element analysis of the meniscus: the influence of geometry and material properties on its behaviour. Knee. 2003 Mar;10(1):33e41. https://doi.org/10.1016/S0968-0160(02)00106-0.

Amendola A, Bonasia DE. The menisci: anatomy, healing response, and biomechanics. Knee Joint. 2012:5e9. https://doi.org/10.1007/978-2-287-99353-4_1.

Seedhom BB, Dowson D, Wright V. Proceedings: functions of the menisci. A preliminary study. Ann Rheum Dis. 1974 Jan;33(1):111. https://doi.org/ 10.1136/ard.33.1.111.

Bin SI, Kim JM, Shin SJ. Radial tears of the posterior horn of the medial meniscus. Arthroscopy. 2004 Apr;20(4):373e378. https://doi.org/10.1016/ j.arthro.2004.01.004.

Messner K, Gao J. The menisci of the knee joint. Anatomical and functional characteristics, and a rationale for clinical treatment. J Anat. 1998 Aug;193(2): 161e178. https://doi.org/10.1046/j.1469-7580.1998.19320161.x.

Harper KW, Helms CA, Lambert HS, Higgins LD. Radial meniscal tears: significance, incidence, and MR appearance. AJR J Roentgenol. 2005 Dec;185(6): 1429e1434. https://doi.org/10.2214/AJR.04.1024.

Kidron A, Thein R. Radial tears associated with cleavage tears of the medial meniscus in athletes. Arthroscopy. 2002 Mar;18(3):254e256. https://doi.org/ 10.1053/jars.2002.30650.

Kim YM, Rhee KJ, Lee JK, Hwang DS, Yang JY, Kim SJ. Arthroscopic pullout repair of a complete radial tear of the tibial attachment site of the medial meniscus posterior horn. Arthroscopy. 2006 Jul;22(7). https://doi.org/10.1016/ j.arthro.2005.12.040, 795.e1ee4.

Smith JP, Barrett GR. Medial and lateral meniscal tear patterns in anterior cruciate ligament-deficient knees. A prospective analysis of 575 tears. Am J Sport Med. 2001 JuleAug;29(4):415e419. https://doi.org/10.1177/03635465010290040501.

Tao SS, Beach WR. Use of a Caspari suture punch to repair a radial tear of the lateral meniscus. Arthroscopy. 2002 Feb;18(2):206e210. https://doi.org/ 10.1053/jars.2002.26858.

Voloshin AS, Wosk J. Shock absorption of meniscectomized and painful knees: a comparative in vivo study. J Biomed Eng. 1983 Apr;5(2):157e161. https:// doi.org/10.1016/0141-5425(83)90036-5.

Yoo JC, Ahn JH, Lee SH, Lee SH, Kim JH. Suturing complete radial tears of the lateral meniscus. Arthroscopy. 2007 Nov;23(11). https://doi.org/10.1016/ j.arthro.2006.07.056, 1249.e1ee7.

Matsubara H, Okazaki K, Izawa T, Tashiro Y, Matsuda S, Nishimura T, et al. New suture method for radial tears of the meniscus: biomechanical analysis of crosssuture and double horizontal suture techniques using cyclic load testing. Am J Sport Med. 2012 Feb;40(2):414e418. https://doi.org/10.1177/0363546511424395.

Choi NH, Kim TH, Son KM, Victoroff BN. Meniscal repair for radial tears of the midbody of the lateral meniscus. Am J Sport Med. 2010 Dec;38(12):2472e2476. https://doi.org/10.1177/0363546510376736.

Haklar U, Kocaoglu B, Nalbanoglu U, Tuzuner T, Guven O. Arthroscopic repair of radial lateral menicus tear by double horizontal sutures with insideeoutside technique. Knee. 2008 Oct;15(5):355e359. https://doi.org/10.1016/j.knee. 2008.05.012.

van Trommel MF, Simonian PT, Potter H, Wickiewicz TL. Arthroscopic meniscal repair with fibrin clot of complete radial tears of the lateral meniscus in the avascular zone. Arthroscopy. 1998 MayeJun;14(4):360e365. https://doi.org/ 10.1016/S0749-8063(98)70002-7.

Ra HJ, Ha JK, Jang SH, Lee DW, Kim JG. Arthroscopic inside-out repair of complete radial tears of the meniscus with a fibrin clot. Knee Surg Sports Traumatol Arthrosc. 2013 Sep;21(9):2126e2130. https://doi.org/10.1007/ s00167-012-2191-3.

Herbort M, Siam S, Lenschow S, Petersen W, Zantop T. Strategies for repair of radial tears close to the meniscal rim-biomechanical analysis with a cyclic loading protocol. Am J Sport Med. 2010 Nov;38(11):2281e2287. https://doi.org/ 10.1177/0363546510382847.

Noyes FR, Barber-Westin SD. Arthroscopic repair of meniscal tears extending into the avascular zone in patients younger than twenty years of age. Am J Sport Med. 2002 JuleAug;30(4):589e600. https://doi.org/10.1177/03635465020300042001.

Bedi A, Kelly NH, Baad M, Fox AJ, Brophy RH, Warren RF, et al. Dynamic contact mechanics of the medial meniscus as a function of radial tear, repair, and partial meniscectomy. J Bone Joint Surg Am. 2010 Jun;92(6):1398e1408. https://doi.org/10.2106/JBJS.I.00539.

Noyes FR, Barber-Westin SD. Arthroscopic repair of meniscus tears extending into the avascular zone with or without anterior cruciate ligament reconstruction in patients 40 years of age and older. Arthroscopy. 2000 Nov;16(8): 822e829. https://doi.org/10.1053/jars.2000.19434.

Magee T, Shapiro M, Williams D. MR accuracy and arthroscopic incidence of meniscal radial tears. Skeletal Radiol. 2002 Dec;31(12):686e689. https:// doi.org/10.1007/s00256-002-0579-8.

Ode GE, Van Thiel GS, McArthur SA, Dishkin-Paset J, Leurgans SE, Shewman EF, et al. Effects of serial sectioning and repair of radial tears in the lateral meniscus. Am J Sport Med. 2012 Aug;40(8):1863e1870. https://doi.org/ 10.1177/0363546512453291.

Rangger C, Kathrein A, Klestil T, Glotzer W. Partial meniscectomy and osteoar- € thritis. Sports Med. 1997 Jan;23(1):61e68. https://doi.org/10.2165/00007256- 199723010-00006.

Knights CB, Gentry C, Bevan S. Partial medial meniscectomy produces osteoarthritis pain-related behaviour in female C57BL/6 mice. Pain. 2012 Feb;153(2): 281e292. https://doi.org/10.1016/j.pain.2011.09.007.

Roos H, Lauren M, Adalberth T, Roos EM, Jonsson K, Lohmander LS. Knee osteoarthritis after meniscectomy: prevalence of radiographic changes after twenty-one years, compared with matched controls. Arthritis Rheum. 1998 Apr;41(4):687e693. https://doi.org/10.1002/1529-0131(199804)41:4<687:: AID-ART16>3.0.CO;2-2.

Branch EA, Milchteim C, Aspey BS, Liu W, Saliman JD, Anz AW. Biomechanical comparison of arthroscopic repair constructs for radial tears of the meniscus. Am J Sport Med. 2015 Sep;43(9):2270e2276. https://doi.org/10.1177/ 0363546515591994.

Petersen W, Tillmann B. Collagenous fibril texture of the human knee joint menisci. Anat Embryol (Berl). 1998 Apr;197(4):317e324. https://doi.org/ 10.1007/s004290050141.
Acta Orthopaedica et Traumatologica Turcica-Cover
  • ISSN: 1017-995X
  • Başlangıç: 2015
  • Yayıncı: Türk Ortopedi ve Travmatoloji Derneği
Sayıdaki Diğer Makaleler

Comparison of ultrasound and extracorporeal shock wave therapy in lateral epicondylosis

Bestami YALVAÇ, Nilgün MESCİ, DUYGU GELER KÜLCÜ, OZAN VOLKAN YURDAKUL

Minimally invasive plate osteosynthesis for tibial derotation osteotomies in children with cerebral palsy

İlker Abdullah SARIKAYA, ALİ ŞEKER, Ozan Ali ERDAL, Mehmet Ali TALMAÇ, Muharrem İNAN

Arthroscopic resection of an osteochondral loose body in the distal radioulnar joint: A case report

Koichi YANO, Yasunori KANESHİRO, Hideki SAKANAAKA

Isotretinoin induced achilles tendinopathy: Histopathological and biomechanical evaluation on rats

Ozan BEYTEMÜR, Serdar YÜKSEL, Ümit Seza TETİKKURT, Erdinç GENÇ, Ercan OLCAY, Akif GÜLEÇ

Results of 4-strand modified Kessler core suture and epitendinous interlocking suture followed by modified Kleinert protocol for flexor tendon repairs in Zone 2

Özgün Barış GÜNTÜRK, Murat KAYALAR, İbrahim KAPLAN, ABUZER ULUDAĞ, Kemal ÖZAKSAR, Beray KELEŞOĞLU

Endless story of a spinal column hydatid cyst disease: A case report

Gökhan ÇAVUŞ, Vedat AÇIK, Emre BİLGİN, Yurdal GEZERCAN, Ali İhsan ÖKTEN

Comment on: “Bicolumnar 90-90 plating of AO 13C Type fractures” ( Author's Reponse )

Cemal KURAL

Comment on: “Bicolumnar 90-90 plating of AO 13C Type fractures” ( Author's Reponse )

Cemal KURAL

The patellar tendon wavy sign as a new secondary sign of ACL tear on MRI

Huijun KANG, Kunpeng FU, Conglei DONG, Fei WANG

First metatarsophalangeal joint arthrodesis with two orthogonal two hole plates

Muhammad Ali FAZAL, Jason Hol-Ming WONG, Luthfur RAHMAN