Purpose
To compare biomechanical properties of various radial tear repair techniques in the
medial and lateral menisci.
Methods
A search was performed for key words regarding mechanical properties of repair of
radial meniscal tears in PubMed, Embase, CINAHL, Scopus, and Cochrane databases, yielding
1791 articles. Articles were screened using Preferred Reporting Items for Systematic
Reviews and Meta-Analyses (PRISMA) guidelines against inclusion criteria and underwent
Methodological Index for Non-Randomized Studies (MINORS) methodologic quality assessment.
Repair constructs evaluated were classified based on repair technique, use of a transtibial
augmentation, and the number, orientation, and pattern of stitches. Results published
across different studies were compared but not subjected to meta-analysis due to variability
in testing procedures and heterogeneity of repair methods.
Results
We identified 20 studies that performed mechanical testing on 21 different radial
meniscal tear repair techniques. The greatest reported mean load-to-failure (LtF)
were the transtibial 2-tunnel + 4 horizontal inside-out sutures (191.2 N ± 17.3, cadaver)
and all-inside double vertical repair (146.3 N ± 36.2, porcine). The transtibial technique
improved LtF and displacement of an inside-out (IO) horizontal repair. All-inside
vertical repairs demonstrated greater LtF, stiffness, and displacement compared with
IO horizontal repairs in 2 studies. Compared with IO double horizontal repairs, all-inside
double vertical or IO double horizontal repairs with reinforcing stitches parallel
to the tear exhibited greater LtF in 3 studies and stiffness in 2 studies. Two studies
reported that parallel reinforcing stitches significantly reduced suture tear-through
compared with similar, nonreinforced repairs. Mean MINORS score for all studies analyzed
was 19.88 ± 1.47 points.
Conclusions
A systematic review demonstrated that there may be alternatives to traditional IO
horizontal repairs for radial meniscus tears. Less-invasive all-inside vertical techniques
reinforced with suture parallel to the tear instead of standard IO horizontal sutures
may improve strength of repair. In addition, transtibial 2-tunnel augmentation may
also increase strength of radial meniscus tear repairs.
Clinical Relevance
There may be alternatives to IO horizontal repairs for radial meniscus tears.
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Article info
Publication history
Published online: February 18, 2022
Accepted:
February 4,
2022
Received:
August 12,
2021
Footnotes
The authors report the following potential conflicts of interest or sources of funding: C.K. reports personal fees from Arthrex and Smith & Nephew, outside the submitted work. D.F. reports grants and other from Smith & Nephew; other from DePuy Mitek; grants and other from Zimmer Biomet and Vericel; other from MTF, KCRN, and Hyalex; and grants and other from CartiHeal, Anika Therapeutics, Aesculap, and Moximed, outside the submitted work. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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