Original Article| Volume 25, ISSUE 9, P959-967, September 2009

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Biomechanical Testing of New Meniscal Repair Techniques Containing Ultra High–Molecular Weight Polyethylene Suture


      To evaluate the biomechanical characteristics of current meniscal repair techniques containing ultra high–molecular weight polyethylene (UHMWPE) suture with and without cyclic loading.


      Vertical longitudinal cuts made in porcine menisci were secured with a single repair device. Noncycled and cycled (500 cycles) biomechanical tests were performed on the following groups: group 1, No. 2-0 Mersilene vertical suture (Ethicon, Somerville, NJ); group 2, No. 2-0 Orthocord vertical suture (DePuy Mitek, Westwood, MA); group 3, No. 0 Ultrabraid vertical suture (Smith & Nephew Endoscopy, Andover, MA); group 4, No. 2-0 FiberWire vertical suture (Arthrex, Naples, FL); group 5, vertically oriented mattress suture by use of an Ultra FasT-Fix device (Smith & Nephew Endoscopy) with No. 0 Ultrabraid; group 6, vertically oriented mattress suture by use of a RapidLoc A2 device (DePuy Mitek) with No. 2-0 Orthocord suture; group 7, vertically oriented stitch by use of a MaxFire device with MaxBraid PE suture (Biomet Sports Medicine, Warsaw, IN); and group 8, an obliquely oriented stitch of No. 0 UHMWPE suture inserted by use of a CrossFix device (Cayenne Medical, Scottsdale, AZ). Endpoints were failure loads, failure modes, stiffness, and cyclic displacement.


      Mean single-pull loads were calculated for Ultra FasT-Fix (121 N), FiberWire (110 N), MaxFire (130 N), Mersilene (84 N), Orthocord (124 N), RapidLoc A2 (86 N), CrossFix (77 N), and Ultrabraid (109 N). After 500 cyclic loads, the Orthocord (222 N) repair was stronger than the others: Ultra FasT-Fix (110 N), FiberWire (117 N), MaxFire (132 N), Mersilene (89 N), RapidLoc A2 (108 N), CrossFix (95 N), and Ultrabraid (126 N) (P < .05). Ultrabraid suture showed significantly more elongation over 500 cycles than the other repairs (P < .05). The principal failure mode associated with the single destructive pull (suture breakage) changed to pulling through the meniscus after cyclic loading for most devices. Knot slippage or device failure was seldom observed as the failure mode with these techniques.


      Self-adjusting, UHMWPE suture–containing meniscal repair devices (Ultra FasT-Fix, RapidLoc A2, and MaxFire) were comparable to the isolated UHMWPE-containing suture repairs on single–failure load testing. UHMWPE-containing suture repairs are stronger than braided polyester suture repairs, but pure UHMWPE suture (Ultrabraid) elongated more during cycling. Orthocord suture is significantly stronger than the other meniscal repair techniques after cyclic loading (P < .05).

      Clinical Relevance

      Meniscal repair techniques using UHMWPE containing sutures provide greater strength than earlier generations of meniscal repair techniques.

      Key Words

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        • Morgan C.D.
        The “all-inside” meniscus repair.
        Arthroscopy. 1991; 7: 120-125
        • Post W.R.
        • Akers S.R.
        • Kish V.
        Load to failure of common meniscal repair techniques: Effects of suture technique and suture material.
        Arthroscopy. 1997; 13: 731-736
        • Rimmer M.G.
        • Nawana N.S.
        • Keene G.C.
        • Pearcy M.J.
        Failure strengths of different meniscal suturing techniques.
        Arthroscopy. 1995; 11: 146-150
        • Maruyama M.
        The all-inside meniscal suture technique using new instruments.
        Arthroscopy. 1996; 12: 256-258
        • Feng H.
        • Hong L.
        • Geng X.S.
        • Zhang H.
        • Wang X.S.
        • Jiang X.Y.
        Second-look arthroscopic evaluation of bucket-handle meniscus tear repairs with anterior cruciate ligament reconstruction: 67 consecutive cases.
        Arthroscopy. 2008; 24: 1358-1366
        • Espejo-Baena A.
        • Figueroa-Mata A.
        • Serrano-Fernandez J.
        • de la Torre-Solis F.
        All-inside suture technique using anterior portals in posterior horn tears of lateral meniscus.
        Arthroscopy. 2008; 24 (Available online at 369.e1-369.e4
        • Albrecht-Olsen P.
        • Lind T.
        • Kristensen G.
        • Falkenberg B.
        Failure strength of a new meniscus arrow repair technique: Biomechanical comparison with horizontal suture.
        Arthroscopy. 1997; 13: 183-187
        • Barber F.A.
        • Coons D.A.
        Midterm results of meniscal repair using the BioStinger meniscal repair device.
        Arthroscopy. 2006; 22: 400-405
        • Barber F.A.
        • Coons D.A.
        • Ruiz-Suarez M.
        Meniscal repair with the RapidLoc meniscal repair device.
        Arthroscopy. 2006; 22: 962-966
        • Haas A.L.
        • Schepsis A.A.
        • Hornstein J.
        • Edgar C.M.
        Meniscal repair using the FasT-Fix all-inside meniscal repair device.
        Arthroscopy. 2005; 21: 167-175
        • Siebold R.
        • Dehler C.
        • Boes L.
        • Ellermann A.
        Arthroscopic all-inside repair using the Meniscus Arrow: Long-term clinical follow-up of 113 patients.
        Arthroscopy. 2007; 23: 394-399
        • Barber F.A.
        • Schroeder F.A.
        • Oro F.B.
        • Beavis R.C.
        FasT-Fix meniscal repair: Mid-term results.
        Arthroscopy. 2008; 24: 1342-1348
        • Kalliakmanis A.
        • Zourntos S.
        • Bousgas D.
        • Nikolaou P.
        Comparison of arthroscopic meniscal repair results using 3 different meniscal repair devices in anterior cruciate ligament reconstruction patients.
        Arthroscopy. 2008; 24: 810-816
        • Barber F.A.
        • Herbert M.A.
        Meniscal repair devices.
        Arthroscopy. 2000; 16: 613-618
        • Barber F.A.
        • Herbert M.A.
        • Richards D.P.
        Load to failure testing of new meniscal repair devices.
        Arthroscopy. 2004; 20: 45-50
        • Borden P.
        • Nyland J.
        • Caborn D.N.
        • Pienkowski D.
        Biomechanical comparison of the FasT-Fix meniscal repair suture system with vertical mattress sutures and meniscus arrows.
        Am J Sports Med. 2003; 31: 374-378
        • Kocabey Y.
        • Taser O.
        • Nyland J.
        • et al.
        Pullout strength of meniscal repair after cyclic loading: Comparison of vertical, horizontal, and oblique suture techniques.
        Knee Surg Sports Traumatol Arthrosc. 2006; 14: 998-1003
        • Naqui S.Z.
        • Thiryayi W.A.
        • Hopgood P.
        • Ryan W.G.
        A biomechanical comparison of the Mitek RapidLoc, Mitek Meniscal repair system, clearfix screws and vertical PDS and Ti-Cron sutures.
        Knee. 2006; 13: 151-157
        • Zantop T.
        • Eggers A.K.
        • Musahl V.
        • Weimann A.
        • Petersen W.
        Cyclic testing of flexible all-inside meniscus suture anchors: Biomechanical analysis.
        Am J Sports Med. 2005; 33: 388-394
        • Barber F.A.
        • Herbert M.A.
        • Coons D.A.
        • Boothby M.H.
        Sutures and suture anchors—Update 2006.
        Arthroscopy. 2006; 22 (1063-1069.e2. Available online at
        • Abbi G.
        • Espinoza L.
        • Odell T.
        • Mahar A.
        • Pedowitz R.
        Evaluation of 5 knots and 2 suture materials for arthroscopic rotator cuff repair: Very strong sutures can still slip.
        Arthroscopy. 2006; 22: 38-43
        • Chang H.C.
        • Nyland J.
        • Caborn D.N.
        • Burden R.
        Biomechanical evaluation of meniscal repair systems: A comparison of the Meniscal Viper Repair System, the vertical mattress FasT-Fix Device, and vertical mattress ethibond sutures.
        Am J Sports Med. 2005; 33: 1846-1852
        • Kocabey Y.
        • Chang H.C.
        • Brand Jr, J.C.
        • Nawab A.
        • Nyland J.
        • Caborn D.N.
        A biomechanical comparison of the FasT-Fix meniscal repair suture system and the RapidLoc device in cadaver meniscus.
        Arthroscopy. 2006; 22: 406-413
        • Barber F.A.
        • Herbert M.A.
        Trinion meniscal screw.
        Arthroscopy. 2006; 22 (Available online at 685.e1-685.e2
        • Richards D.P.
        • Barber F.A.
        • Herbert M.A.
        Meniscal tear biomechanics: Loads across meniscal tears in human cadaveric knees.
        Orthopedics. 2008; 31: 347-350
        • Zhang Z.
        • Arnold J.A.
        • Williams T.
        • McCann B.
        Repairs by trephination and suturing of longitudinal injuries in the avascular area of the meniscus in goats.
        Am J Sports Med. 1995; 23: 35-41
        • Kawai Y.
        • Fukubayashi T.
        • Nishino J.
        Meniscal suture.
        Clin Orthop Relat Res. 1989; : 286-293
        • Becker R.
        • Brettschneider O.
        • Grobel K.H.
        • von Versen R.
        • Starke C.
        Distraction forces on repaired bucket-handle lesions in the medial meniscus.
        Am J Sports Med. 2006; 34: 1941-1947
        • Richards D.P.
        • Barber F.A.
        • Herbert M.A.
        Compressive loads in longitudinal lateral meniscus tears: A biomechanical study in porcine knees.
        Arthroscopy. 2005; 21: 1452-1456

      Linked Article

      • Meniscal Repair Device
        ArthroscopyVol. 26Issue 5
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          We read with interest the article by Barber et al.1 entitled “Biomechanical testing of new meniscal repair techniques containing ultra high–molecular weight polyethylene suture.” In this article Dr. Barber presents data on a DePuy Mitek product called RapidLoc A2.
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