Cyclic Test Comparison of All-Inside Device and Inside-Out Sutures for Radial Meniscus Lesion Repair: An In Vitro Porcine Model Study
Cyclic Test Comparison of All-Inside Device and Inside-Out Sutures for Radial Meniscus Lesion Repair: An In Vitro Porcine Model Study
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DOI：
10.1016/j.arthro.2012.06.015
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发表时间：
2012-12-01
影响因子：
4.7
通讯作者：
Caborn, David N. M.
中科院分区：
文献类型：
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作者：
Lee, Yee Han Dave;Nyland, John;Caborn, David N. M.
目的：比较新型半月板全内缝合修复方法与传统内向外缝合方法修复半月板损伤的生物力学固定及缺口特性。方法：取新鲜冷冻猪胫骨，附着外侧半月板和关节囊，在-20℃下保存48h，解冻12h后，随机分为2组，每组8例。标准化放射状病变采用Sequent装置(ConMed Linvatec，Largo，FL)修复(第1组)或常规内向外缝合2-0号编织聚酯缝合线(第2组)。修复后的标本被放置在定制的夹具中，并安装在伺服液压设备上。在2-N预加载后，试件在5~20N(0.1 Hz)的范围内循环，然后在5~20N(0.5 Hz)之间进行1000次次最大载荷循环。在100、500和1000个周期的40秒延迟使数字照片能够被拍摄用于间隙测量确定。然后对试件进行载荷-失效试验(12.5 mm/S)。记录固定失败模式。结果：在1、100、500和1000次最大载荷循环后，各组的位移没有差异。在100、500和1000次最大负荷周期下，组峰值间隔没有差别。失效时的载荷以及载荷到失效测试期间的位移和刚度在不同组之间没有差异。在加载到失败的测试中，全内试件因种植体从半月板周围移位而失败，而内向外修复的试件因缝线断裂而失败。结论：在受控的体外生物力学测试条件下，全内固定装置提供的放射状半月板损伤固定与传统的内向外缝合相当，但并不优于传统的内向外缝合。临床意义：全内径向外侧半月板损伤修复方法可以提供与传统内向外缝合相当的固定，而不需要额外的切开及其相关的神经血管损伤风险。
Purpose: To compare biomechanical fixation and gapping characteristics of a new all-inside meniscus repair method for radial meniscus lesion repair versus conventional inside-out suture repair under submaximal cyclic loading and load-to-failure test conditions. Methods: Fresh-frozen porcine tibiae with attached lateral menisci and joint capsules were harvested and stored for 48 hours at -20 degrees C. After thawing for 12 hours, equivalent-size healthy specimens were randomly assigned to 2 groups of 8 specimens each. Standardized radial lesions were repaired with the Sequent device (ConMed Linvatec, Largo, FL) (group 1) or conventional inside-out suturing with No. 2-0 braided polyester suture (group 2). Repaired specimens were placed in custom clamps and mounted on a servohydraulic device. After a 2-N preload, specimens were cycled from 5 to 20 N (0.1 Hz), before undergoing 1,000 submaximal loading cycles between 5 and 20 N (0.5 Hz). A 40-second delay at 100, 500, and 1,000 cycles enabled digital photographs to be taken for gapping measurement determination. Specimens then underwent load-to-failure testing (12.5 mm/s). Fixation failure mode was documented. Results: Group displacement did not differ after 1, 100, 500, and 1,000 submaximal loading cycles. Group peak gapping did not differ at 100, 500, and 1,000 submaximal loading cycles. Load at failure and displacement and stiffness during load-to-failure testing did not differ between groups. During load-to-failure testing, all-inside specimens failed by implant dislodgement from the meniscus periphery whereas the inside-out repaired specimens failed by suture rupture. Conclusions: Under controlled in vitro biomechanical test conditions, the all-inside device provided radial meniscus lesion fixation that was comparable, but not superior, to conventional inside-out suturing. Clinical Relevance: The all-inside radial lateral meniscus lesion repair method may provide comparable fixation to conventional inside-out suturing without the need for additional incisions and their associated neurovascular injury risks.