Purpose
To evaluate the biomechanical characteristics of current meniscal repair techniques
containing ultra high–molecular weight polyethylene (UHMWPE) suture with and without
cyclic loading.
Methods
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.
Results
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.
Conclusions
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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Article info
Publication history
Accepted:
March 23,
2009
Received:
September 4,
2008
Footnotes
The authors report no conflict of interest.
Identification
Copyright
© 2009 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
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