Biomechanical Evaluation of an All-Inside Posterior Medial Meniscal Root Repair Technique Via Suture Fixation to the Posterior Cruciate Ligament
To evaluate the tibiofemoral contact mechanics of an all-inside posterior medial meniscal root repair technique via suture fixation to the posterior cruciate ligament (PCL) and to compare with that of the intact knee and the knee with a root tear. Tibiofemoral contact mechanics were recorded in 8 hu...
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| Veröffentlicht in: | Arthroscopy 2020-09, Vol.36 (9), p.2488-2497.e6 |
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| creator | Saltzman, Bryan M. Habet, Nahir A. Rao, Allison J. Trofa, David P. Corpus, Keith T. Yeatts, Nicholas C. Odum, Susan M. Carrillo Garcia, Juan C. Varkey, Dax T. Piasecki, Dana P. Fleischli, James E. |
| description | To evaluate the tibiofemoral contact mechanics of an all-inside posterior medial meniscal root repair technique via suture fixation to the posterior cruciate ligament (PCL) and to compare with that of the intact knee and the knee with a root tear.
Tibiofemoral contact mechanics were recorded in 8 human cadaveric knee specimens using pressure sensors. Each knee underwent 3 testing conditions related to the posterior medial meniscal root: (1) intact knee; (2) root tear; and (3) all-inside repair via suture fixation to the PCL. Knees were loaded with a 1000-N axial compressive force at 4 knee flexion angles (0°, 30°, 60°, 90°). Calculations were performed for contact area, mean contact pressure, and peak contact pressure. A generalized linear model with a Tukey adjusted least square means test was used to determine differences between testing conditions.
Across all knee flexion angles, there was an overall mean 26.3% reduction in contact area with root tear (211.34 mm2 vs intact 286.64 mm2, P = .0002), and a 31.6% increase from root tear to repair (277.61 mm2, P = .0297). Across all knee flexion angles, there was an overall mean 24.3% increase in contact pressure with root tear (1849.12 N/mm2 vs. intact 1487.52 N/mm2, P < .0001), and a 31.1% decrease from root tear to repair (1410.7 N/mm2, P = .0037). Across all knee flexion angles, there was an overall mean 10.6% increase in peak contact pressure with root tear (4083.55 N/mm2 vs. intact 3693.68 N/mm2, P < .0001), and a 12.4% decrease from root tear to repair (3632.13 N/mm2, P = .531).
In most testing conditions and with overall averaging across knee flexion angles, the all-inside posterior medial meniscal root repair with suture fixation to the adjacent PCL fibers restored contact area (from 26.3% reduction with root tear to 31.6% increase with repair), contact pressures (from 24.3% increase with root tear to 31.1% decrease with repair), and peak contact pressures (from 10.6% increase with root tear to 12.4% decrease with repair) to that of the intact knee This may be a future potential technique to limit complications associated with the traditional transtibial pull-out method of repair.
This technique may provide a posterior medial meniscal root repair construct that restores most tibiofemoral contact mechanics and offers theoretical benefits of technical ease and potential for an acceptable, less “anatomic” repair location. |
| doi_str_mv | 10.1016/j.arthro.2020.04.042 |
| format | Article |
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Tibiofemoral contact mechanics were recorded in 8 human cadaveric knee specimens using pressure sensors. Each knee underwent 3 testing conditions related to the posterior medial meniscal root: (1) intact knee; (2) root tear; and (3) all-inside repair via suture fixation to the PCL. Knees were loaded with a 1000-N axial compressive force at 4 knee flexion angles (0°, 30°, 60°, 90°). Calculations were performed for contact area, mean contact pressure, and peak contact pressure. A generalized linear model with a Tukey adjusted least square means test was used to determine differences between testing conditions.
Across all knee flexion angles, there was an overall mean 26.3% reduction in contact area with root tear (211.34 mm2 vs intact 286.64 mm2, P = .0002), and a 31.6% increase from root tear to repair (277.61 mm2, P = .0297). Across all knee flexion angles, there was an overall mean 24.3% increase in contact pressure with root tear (1849.12 N/mm2 vs. intact 1487.52 N/mm2, P < .0001), and a 31.1% decrease from root tear to repair (1410.7 N/mm2, P = .0037). Across all knee flexion angles, there was an overall mean 10.6% increase in peak contact pressure with root tear (4083.55 N/mm2 vs. intact 3693.68 N/mm2, P < .0001), and a 12.4% decrease from root tear to repair (3632.13 N/mm2, P = .531).
In most testing conditions and with overall averaging across knee flexion angles, the all-inside posterior medial meniscal root repair with suture fixation to the adjacent PCL fibers restored contact area (from 26.3% reduction with root tear to 31.6% increase with repair), contact pressures (from 24.3% increase with root tear to 31.1% decrease with repair), and peak contact pressures (from 10.6% increase with root tear to 12.4% decrease with repair) to that of the intact knee This may be a future potential technique to limit complications associated with the traditional transtibial pull-out method of repair.
This technique may provide a posterior medial meniscal root repair construct that restores most tibiofemoral contact mechanics and offers theoretical benefits of technical ease and potential for an acceptable, less “anatomic” repair location.</description><identifier>ISSN: 0749-8063</identifier><identifier>EISSN: 1526-3231</identifier><identifier>DOI: 10.1016/j.arthro.2020.04.042</identifier><identifier>PMID: 32438029</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Arthroplasty, Replacement, Knee ; Biomechanical Phenomena ; Cadaver ; Female ; Humans ; Knee Injuries - surgery ; Knee Joint - surgery ; Lacerations - surgery ; Male ; Menisci, Tibial - surgery ; Middle Aged ; Posterior Cruciate Ligament - surgery ; Pressure ; Range of Motion, Articular ; Rupture - surgery ; Suture Techniques ; Tibial Meniscus Injuries - surgery</subject><ispartof>Arthroscopy, 2020-09, Vol.36 (9), p.2488-2497.e6</ispartof><rights>2020 Arthroscopy Association of North America</rights><rights>Copyright © 2020 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c428t-7a940d4def6b547094b08346644624ca1dfa9dbf48e8510f7e4cc769bf45a57d3</citedby><cites>FETCH-LOGICAL-c428t-7a940d4def6b547094b08346644624ca1dfa9dbf48e8510f7e4cc769bf45a57d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0749806320303777$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32438029$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Saltzman, Bryan M.</creatorcontrib><creatorcontrib>Habet, Nahir A.</creatorcontrib><creatorcontrib>Rao, Allison J.</creatorcontrib><creatorcontrib>Trofa, David P.</creatorcontrib><creatorcontrib>Corpus, Keith T.</creatorcontrib><creatorcontrib>Yeatts, Nicholas C.</creatorcontrib><creatorcontrib>Odum, Susan M.</creatorcontrib><creatorcontrib>Carrillo Garcia, Juan C.</creatorcontrib><creatorcontrib>Varkey, Dax T.</creatorcontrib><creatorcontrib>Piasecki, Dana P.</creatorcontrib><creatorcontrib>Fleischli, James E.</creatorcontrib><title>Biomechanical Evaluation of an All-Inside Posterior Medial Meniscal Root Repair Technique Via Suture Fixation to the Posterior Cruciate Ligament</title><title>Arthroscopy</title><addtitle>Arthroscopy</addtitle><description>To evaluate the tibiofemoral contact mechanics of an all-inside posterior medial meniscal root repair technique via suture fixation to the posterior cruciate ligament (PCL) and to compare with that of the intact knee and the knee with a root tear.
Tibiofemoral contact mechanics were recorded in 8 human cadaveric knee specimens using pressure sensors. Each knee underwent 3 testing conditions related to the posterior medial meniscal root: (1) intact knee; (2) root tear; and (3) all-inside repair via suture fixation to the PCL. Knees were loaded with a 1000-N axial compressive force at 4 knee flexion angles (0°, 30°, 60°, 90°). Calculations were performed for contact area, mean contact pressure, and peak contact pressure. A generalized linear model with a Tukey adjusted least square means test was used to determine differences between testing conditions.
Across all knee flexion angles, there was an overall mean 26.3% reduction in contact area with root tear (211.34 mm2 vs intact 286.64 mm2, P = .0002), and a 31.6% increase from root tear to repair (277.61 mm2, P = .0297). Across all knee flexion angles, there was an overall mean 24.3% increase in contact pressure with root tear (1849.12 N/mm2 vs. intact 1487.52 N/mm2, P < .0001), and a 31.1% decrease from root tear to repair (1410.7 N/mm2, P = .0037). Across all knee flexion angles, there was an overall mean 10.6% increase in peak contact pressure with root tear (4083.55 N/mm2 vs. intact 3693.68 N/mm2, P < .0001), and a 12.4% decrease from root tear to repair (3632.13 N/mm2, P = .531).
In most testing conditions and with overall averaging across knee flexion angles, the all-inside posterior medial meniscal root repair with suture fixation to the adjacent PCL fibers restored contact area (from 26.3% reduction with root tear to 31.6% increase with repair), contact pressures (from 24.3% increase with root tear to 31.1% decrease with repair), and peak contact pressures (from 10.6% increase with root tear to 12.4% decrease with repair) to that of the intact knee This may be a future potential technique to limit complications associated with the traditional transtibial pull-out method of repair.
This technique may provide a posterior medial meniscal root repair construct that restores most tibiofemoral contact mechanics and offers theoretical benefits of technical ease and potential for an acceptable, less “anatomic” repair location.</description><subject>Adult</subject><subject>Arthroplasty, Replacement, Knee</subject><subject>Biomechanical Phenomena</subject><subject>Cadaver</subject><subject>Female</subject><subject>Humans</subject><subject>Knee Injuries - surgery</subject><subject>Knee Joint - surgery</subject><subject>Lacerations - surgery</subject><subject>Male</subject><subject>Menisci, Tibial - surgery</subject><subject>Middle Aged</subject><subject>Posterior Cruciate Ligament - surgery</subject><subject>Pressure</subject><subject>Range of Motion, Articular</subject><subject>Rupture - surgery</subject><subject>Suture Techniques</subject><subject>Tibial Meniscus Injuries - surgery</subject><issn>0749-8063</issn><issn>1526-3231</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9UdtqFEEQbUQx6-ofiPSjL7OpvsztRYhLYgIbDDH62vR217i9zEyv3T3B_IWfnF4mSp6EgoLinFNV5xDynsGKAatO9ysd0i74FQcOK5C5-AuyYCWvCsEFe0kWUMu2aKASJ-RNjHsAEKIRr8mJ4FI0wNsF-fPZ-QHNTo_O6J6e3-t-0sn5kfqO6pGe9X1xNUZnkd74mDA4H-g1WpfB1zi6eGTdep_oLR60C_Qui43u14T0h9P025SmgPTC_Z5Fk6dp91xqHSbjdEK6cT_1gGN6S151uo_47qkvyfeL87v1ZbH5-uVqfbYpjORNKmrdSrDSYldtS1lDK7fQCFlVUlZcGs1sp1u77WSDTcmgq1EaU1dtnpS6rK1Yko-z7iH4fG1MasjPYN_rEf0UFZfZNwaQnVoSOUNN8DEG7NQhuEGHB8VAHbNQezVnoY5ZKJC5eKZ9eNowbQe0_0h_zc-ATzMA85_3DoOKxuFosrsBTVLWu_9veASWs55y</recordid><startdate>202009</startdate><enddate>202009</enddate><creator>Saltzman, Bryan M.</creator><creator>Habet, Nahir A.</creator><creator>Rao, Allison J.</creator><creator>Trofa, David P.</creator><creator>Corpus, Keith T.</creator><creator>Yeatts, Nicholas C.</creator><creator>Odum, Susan M.</creator><creator>Carrillo Garcia, Juan C.</creator><creator>Varkey, Dax T.</creator><creator>Piasecki, Dana P.</creator><creator>Fleischli, James E.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>202009</creationdate><title>Biomechanical Evaluation of an All-Inside Posterior Medial Meniscal Root Repair Technique Via Suture Fixation to the Posterior Cruciate Ligament</title><author>Saltzman, Bryan M. ; Habet, Nahir A. ; Rao, Allison J. ; Trofa, David P. ; Corpus, Keith T. ; Yeatts, Nicholas C. ; Odum, Susan M. ; Carrillo Garcia, Juan C. ; Varkey, Dax T. ; Piasecki, Dana P. ; Fleischli, James E.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c428t-7a940d4def6b547094b08346644624ca1dfa9dbf48e8510f7e4cc769bf45a57d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adult</topic><topic>Arthroplasty, Replacement, Knee</topic><topic>Biomechanical Phenomena</topic><topic>Cadaver</topic><topic>Female</topic><topic>Humans</topic><topic>Knee Injuries - surgery</topic><topic>Knee Joint - surgery</topic><topic>Lacerations - surgery</topic><topic>Male</topic><topic>Menisci, Tibial - surgery</topic><topic>Middle Aged</topic><topic>Posterior Cruciate Ligament - surgery</topic><topic>Pressure</topic><topic>Range of Motion, Articular</topic><topic>Rupture - surgery</topic><topic>Suture Techniques</topic><topic>Tibial Meniscus Injuries - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Saltzman, Bryan M.</creatorcontrib><creatorcontrib>Habet, Nahir A.</creatorcontrib><creatorcontrib>Rao, Allison J.</creatorcontrib><creatorcontrib>Trofa, David P.</creatorcontrib><creatorcontrib>Corpus, Keith T.</creatorcontrib><creatorcontrib>Yeatts, Nicholas C.</creatorcontrib><creatorcontrib>Odum, Susan M.</creatorcontrib><creatorcontrib>Carrillo Garcia, Juan C.</creatorcontrib><creatorcontrib>Varkey, Dax T.</creatorcontrib><creatorcontrib>Piasecki, Dana P.</creatorcontrib><creatorcontrib>Fleischli, James E.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Arthroscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Saltzman, Bryan M.</au><au>Habet, Nahir A.</au><au>Rao, Allison J.</au><au>Trofa, David P.</au><au>Corpus, Keith T.</au><au>Yeatts, Nicholas C.</au><au>Odum, Susan M.</au><au>Carrillo Garcia, Juan C.</au><au>Varkey, Dax T.</au><au>Piasecki, Dana P.</au><au>Fleischli, James E.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Biomechanical Evaluation of an All-Inside Posterior Medial Meniscal Root Repair Technique Via Suture Fixation to the Posterior Cruciate Ligament</atitle><jtitle>Arthroscopy</jtitle><addtitle>Arthroscopy</addtitle><date>2020-09</date><risdate>2020</risdate><volume>36</volume><issue>9</issue><spage>2488</spage><epage>2497.e6</epage><pages>2488-2497.e6</pages><issn>0749-8063</issn><eissn>1526-3231</eissn><abstract>To evaluate the tibiofemoral contact mechanics of an all-inside posterior medial meniscal root repair technique via suture fixation to the posterior cruciate ligament (PCL) and to compare with that of the intact knee and the knee with a root tear.
Tibiofemoral contact mechanics were recorded in 8 human cadaveric knee specimens using pressure sensors. Each knee underwent 3 testing conditions related to the posterior medial meniscal root: (1) intact knee; (2) root tear; and (3) all-inside repair via suture fixation to the PCL. Knees were loaded with a 1000-N axial compressive force at 4 knee flexion angles (0°, 30°, 60°, 90°). Calculations were performed for contact area, mean contact pressure, and peak contact pressure. A generalized linear model with a Tukey adjusted least square means test was used to determine differences between testing conditions.
Across all knee flexion angles, there was an overall mean 26.3% reduction in contact area with root tear (211.34 mm2 vs intact 286.64 mm2, P = .0002), and a 31.6% increase from root tear to repair (277.61 mm2, P = .0297). Across all knee flexion angles, there was an overall mean 24.3% increase in contact pressure with root tear (1849.12 N/mm2 vs. intact 1487.52 N/mm2, P < .0001), and a 31.1% decrease from root tear to repair (1410.7 N/mm2, P = .0037). Across all knee flexion angles, there was an overall mean 10.6% increase in peak contact pressure with root tear (4083.55 N/mm2 vs. intact 3693.68 N/mm2, P < .0001), and a 12.4% decrease from root tear to repair (3632.13 N/mm2, P = .531).
In most testing conditions and with overall averaging across knee flexion angles, the all-inside posterior medial meniscal root repair with suture fixation to the adjacent PCL fibers restored contact area (from 26.3% reduction with root tear to 31.6% increase with repair), contact pressures (from 24.3% increase with root tear to 31.1% decrease with repair), and peak contact pressures (from 10.6% increase with root tear to 12.4% decrease with repair) to that of the intact knee This may be a future potential technique to limit complications associated with the traditional transtibial pull-out method of repair.
This technique may provide a posterior medial meniscal root repair construct that restores most tibiofemoral contact mechanics and offers theoretical benefits of technical ease and potential for an acceptable, less “anatomic” repair location.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>32438029</pmid><doi>10.1016/j.arthro.2020.04.042</doi></addata></record> |
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| ispartof | Arthroscopy, 2020-09, Vol.36 (9), p.2488-2497.e6 |
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| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Adult Arthroplasty, Replacement, Knee Biomechanical Phenomena Cadaver Female Humans Knee Injuries - surgery Knee Joint - surgery Lacerations - surgery Male Menisci, Tibial - surgery Middle Aged Posterior Cruciate Ligament - surgery Pressure Range of Motion, Articular Rupture - surgery Suture Techniques Tibial Meniscus Injuries - surgery |
| title | Biomechanical Evaluation of an All-Inside Posterior Medial Meniscal Root Repair Technique Via Suture Fixation to the Posterior Cruciate Ligament |
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