Biomechanical Comparison of 3 Novel Repair Techniques for Radial Tears of the Medial Meniscus: The 2-Tunnel Transtibial Technique, a "Hybrid" Horizontal and Vertical Mattress Suture Configuration, and a Combined "Hybrid Tunnel" Technique
Biomechanical Comparison of 3 Novel Repair Techniques for Radial Tears of the Medial Meniscus: The 2-Tunnel Transtibial Technique, a "Hybrid" Horizontal and Vertical Mattress Suture Configuration, and a Combined "Hybrid Tunnel" Technique
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DOI：
10.1177/0363546518816949
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发表时间：
2019-03-01
影响因子：
4.8
通讯作者：
LaPrade, Robert F.
中科院分区：
文献类型：
--
作者：
Buckley, Patrick S.;Kemler, Bryson R.;LaPrade, Robert F.
背景：历史上，桡骨远端撕裂通常采用部分或接近全切的方法治疗，结果通常不佳。桡动脉撕裂的功能类似于全椎间盘切除术，治疗具有挑战性。应进行桡动脉撕裂修复，以防止关节恶化和将来需要挽救手术。目的/假设：目的是比较内侧半月板放射状撕裂的3种修复技术：双隧道、混合和混合隧道技术。假设3组之间在间隙和最终失效强度方面没有差异。研究设计：对照实验室研究。研究方法：使用30例男性尸体膝关节（10对配对，n = 20; 10对非配对，n = 10）比较双隧道、混合和混合隧道修复。在内侧半月板的中间体处形成完全的径向撕裂。根据所述技术进行修复。将样本灌封并安装在通用材料试验机上，其中每个样本在经历拉伸失效之前循环加载1000次。测量并记录撕裂部位的间隙距离、极限失效载荷和失效位置。结果如下：在1000次循环载荷后，双隧道修复（3.0 +/- 1.7 mm）、混合修复（3.0 +/- 0.9 mm）和混合隧道修复（2.3 +/- 1.0 mm; P = 0.4042）之间的位移无显著差异。在拉力失效测试中，2隧道修复（259 +/- 103 N）、混合修复（349 +/- 149 N）和混合隧道修复（365 +/- 146 N; P = 0.26）之间的极限失效强度也无显著差异。然而，与双隧道修复（7/9，78%; P = 0.017）相比，添加垂直褥式缝合作为“止裂器”显著降低了混合和混合隧道修复（4/16，25%）在拉力失效测试期间缝线穿过半月板的可能性。结论：结果表明，3种修复体在间隙距离和拉力失效强度方面的生物力学测试等同。增加垂直褥式缝合作为止裂器可有效防止半月板切出。
Background: Historically, radial meniscal tears were treated with partial or near-total meniscectomy, which usually resulted in poor outcomes. Radial meniscal tears function similar to a total meniscectomy and are challenging to treat. Repair of radial meniscal tears should be performed to prevent joint deterioration and the need for salvage procedures in the future. Purpose/Hypothesis: The purpose was to compare 3 repair techniques for radial tears of the medial meniscus: the 2-tunnel, hybrid, and hybrid tunnel techniques. It was hypothesized that there would be no differences among the 3 groups in regard to gapping and ultimate failure strength. Study Design: Controlled laboratory study. Methods: Thirty human male cadaver knees (10 matched pairs, n = 20; 10 unpaired, n = 10) were used to compare the 2-tunnel, hybrid, and hybrid tunnel repairs. A complete radial tear was made at the midbody of the medial meniscus. Repairs were performed according to the described techniques. Specimens were potted and mounted on a universal material testing machine where each specimen was cyclically loaded for 1000 cycles before experiencing a pull to failure. Gap distances at the tear site, ultimate failure load, and failure location were measured and recorded. Results: After 1000 cycles of cyclic loading, there were no significant differences in displacement among the 2-tunnel repair (3.0 +/- 1.7 mm), hybrid repair (3.0 +/- 0.9 mm), and hybrid tunnel repair (2.3 +/- 1.0 mm; P = .4042). On pull-to-failure testing, there were also no significant differences in ultimate failure strength among the 2-tunnel repair (259 +/- 103 N), hybrid repair (349 +/- 149 N), and hybrid tunnel repair (365 +/- 146 N; P = .26). However, the addition of vertical mattress sutures to act as a "rip stop" significantly reduced the likelihood of the sutures pulling through the meniscus during pull-to-failure testing for the hybrid and hybrid tunnel repairs (4 of 16, 25%) as compared with the 2-tunnel repair (7 of 9, 78%; P = .017). Conclusion: The results showed equivalent biomechanical testing with regard to gap distance and pull-to-failure strength among the 3 repairs. The addition of the vertical mattress sutures to act as a rip stop was effective in preventing meniscal cutout through the meniscus.