Contributions to displacement and resistance of the meniscus-suture complex in transtibial meniscal root repair

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Recent Topics on Mechanics and Materials in Design

M2D2019 143-1

PAPER REF: 143

CONTRIBUTIONS TO DISPLACEMENT AND RESISTANCE OF THE

COMPONENTS OF THE MENISCUS-SUTURE COMPLEX IN

TRANSTIBIAL MENISCAL ROOT REPAIR

Ana Pérez-Blanca1(*)_{, María Prado Nóvoa}1_{, Belén Estebanez}1_{, Fernando Nadal}1_{, Alejandro Espejo-Reina}2_,

Marco Cecarelli3

1_{Laboratory of Biomechanics, University of Malaga, Malaga, Spain} 2_H_{ospital Vithas Parque San Antonio, Malaga, Spain}

3_{Department of Mechanical Engineering, University of Rome Tor Vergata, Italy} (*)_Email:_{[email protected]}

ABSTRACT

This work analyses in a porcine model the contributions of meniscal tissue, suture thread and meniscus-suture interaction to the permanent displacements generated at the repaired root after surgery to re-insert the posterior meniscal root using a transtibial pullout technique. Medial porcine menisci with a single suture applied at the posterior horn were subjected to cyclic and load-to-failure tests. Elongations of the different components of the meniscus-suture complex were determined applying photogrammetry. Results showed that after low intensity cyclic loading, the main contribution to permanent root displacements was due to the thread (51.2%), while no cutting of the suture through tissue occur at the interface. Under load-to-failure conditions, suture cutting started at a significantly higher load level (Suture Retention Strength, SRS), always before and close to the first local maximum of the load-elongation curve, and progressed rapidly afterwards causing the final failure of all specimens.

Keywords: biomechanical properties, posterior meniscal root, Transtibial pull-out repair, permanent displacements, Suture Retention Strength.

INTRODUCTION

Transtibial root repairs are frequent as meniscal root tears become increasingly recognized.

Development of permanent root displacements in the early post-operative period should be minimized (Cerminara, 2014), to re-establish proper meniscal function (Stärke, 2010). To improve the surgical technique, a better knowledge of the contributions to displacement of the different components involved in the repair is necessary. This study focus in the mechanical behavior of the isolated meniscus-suture complex, including the characterization of SRS at the posterior meniscal horn, a fundamental tissue property for surgical repair success.

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8th International Conference on Mechanics and Materials in Design

Bologna/Italy, 4-6 September 2019

143-2

Fig. 1 - (a) Experimental setup. White arrows point out the ink marks on the different components. (b) Interface of the software Ini-cut, specifically develop to extract progression of elongations with loading from ink marks

RESULTS AND CONCLUSIONS

From cyclic test, the component that contributed the most to residual displacement was the thread with up to 51.20% of total residual displacement (Table 1). Tissue compaction at the interface contributed a 21.19%, but the suture did not cut through the tissue.

Table 1 – Initial length andresidual displacement from cyclic tests

Insertion hole Suture thread Meniscal tissue TOTAL

Mean (SD) Mean (SD) Mean (SD) Mean (SD)

(mm) 1.67 (0.51) 40.64 (5.63) 6.63 (1.45) 48.93 (5.31)

(mm) 0.37 (0.25) 1.14 (0.70) 0.50 (0.35) 2.01 (0.90)

21.19 (12.48) 51.20 (18.90) 27.61 (15.74)

In load-to-failure, evolution of elongations showed a slope change at the same instant for all components (Fig. 2), coincident with the initiation of suture cutting through tissue in the images which occurred always close but before the first local maximum of the load-elongation curve (Fig. 2), at mean displacement of 3.2 mm and a mean load (SRS) of 97.5 N, a 10.2% lower than ultimate failure load (UFL). Once cut initiated, unpredictable permanent displacements generated, reaching a mean value of 6.9 mm at a UFL of 109.2N

Fig. 1 – Mean curves from load-to-failure tests. Vertical lines mark tissue cut initiation.

In conclusion, suture thread contributes the most to permanent root displacements of the meniscus-suture complex in a porcine model under low intensity cyclic loading, and no cutting of the tissue occurs until SRS values of much higher intensity, after which cut progress rapidly.

REFERENCES

Cerminara AJ, LaPrade CM et al. Biomechanical evaluation of a transtibial pull-out meniscal root repair: challenging the bungee effect. Am J Sports Med, 2014, 42, p. 2988-2995

Stärke C, Kopf S, Grobel K, Becker R.The effect of a non-anatomical repair of the meniscal horn attachment on meniscal tension: a biomechanical study. Arthroscopy, 2010, 26, p. 358-365