Jay M Patel1,2,3, Andrzej Brzezinski1, Deep A Raole1, Michael G Dunn1,2, Charles J Gatt1,2. 1. Department of Orthopaedic Surgery, Robert Wood Johnson Medical School, Rutgers Biomedical and Health Sciences, New Brunswick, New Jersey, USA. 2. Department of Biomedical Engineering, Rutgers University, Piscataway, New Jersey, USA. 3. McKay Orthopaedic Research Laboratory, Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Abstract
BACKGROUND: Meniscal lesions represent one of the most common intra-articular knee injuries. Meniscus replacement devices are needed to restore load distribution and knee stability after meniscectomy. Fixation of these devices is crucial to the generation of hoop stresses and the distribution of loads in the joint. PURPOSE: To evaluate 2 different fixation techniques (suture endobutton and interference screw) for implantation of a novel meniscus device. STUDY DESIGN: Controlled laboratory study. METHODS: In 7 human cadaveric knees (aged 17-61 years), 1 anterior and 2 potential posterior tunnel locations were investigated, and both fixation techniques were tested in each tunnel. The native meniscus roots, devices fixed with a suture endobutton, and devices fixed with an interference screw were gripped with cryoclamps, and tibias were drilled and loaded into a custom jig. Samples were preloaded, preconditioned, loaded for 500 cycles (50-150 N), and tested in tension until failure. RESULTS: For all 3 tunnels, suture fixation resulted in greater elongation (54.1%-150.7% greater; P < .05) during cyclic loading than interference screw fixation, which approximated the native roots. Both fixation techniques displayed ultimate tensile loads in the same range as native roots. However, stiffness of the suture fixation groups (36.5-41.6 N/mm) was only 28% to 37% of that of the interference screw fixation groups (98.7-131.6 N/mm), which had values approaching those of the native roots (anterior: 175.4 ± 24.2 N/mm; posterior: 157.6 ± 22.9 N/mm). CONCLUSION: Interference screw fixation was found to be superior to suture fixation with regard to elongation and stiffness, a finding that should be considered in the design and implantation of novel meniscus replacement devices. CLINICAL RELEVANCE: With the emergence of various devices for total meniscus replacement, the establishment of fixation strategies is crucial for the generation of tensile hoop stresses and the efficacy of these approaches.
BACKGROUND: Meniscal lesions represent one of the most common intra-articular knee injuries. Meniscus replacement devices are needed to restore load distribution and knee stability after meniscectomy. Fixation of these devices is crucial to the generation of hoop stresses and the distribution of loads in the joint. PURPOSE: To evaluate 2 different fixation techniques (suture endobutton and interference screw) for implantation of a novel meniscus device. STUDY DESIGN: Controlled laboratory study. METHODS: In 7 human cadaveric knees (aged 17-61 years), 1 anterior and 2 potential posterior tunnel locations were investigated, and both fixation techniques were tested in each tunnel. The native meniscus roots, devices fixed with a suture endobutton, and devices fixed with an interference screw were gripped with cryoclamps, and tibias were drilled and loaded into a custom jig. Samples were preloaded, preconditioned, loaded for 500 cycles (50-150 N), and tested in tension until failure. RESULTS: For all 3 tunnels, suture fixation resulted in greater elongation (54.1%-150.7% greater; P < .05) during cyclic loading than interference screw fixation, which approximated the native roots. Both fixation techniques displayed ultimate tensile loads in the same range as native roots. However, stiffness of the suture fixation groups (36.5-41.6 N/mm) was only 28% to 37% of that of the interference screw fixation groups (98.7-131.6 N/mm), which had values approaching those of the native roots (anterior: 175.4 ± 24.2 N/mm; posterior: 157.6 ± 22.9 N/mm). CONCLUSION: Interference screw fixation was found to be superior to suture fixation with regard to elongation and stiffness, a finding that should be considered in the design and implantation of novel meniscus replacement devices. CLINICAL RELEVANCE: With the emergence of various devices for total meniscus replacement, the establishment of fixation strategies is crucial for the generation of tensile hoop stresses and the efficacy of these approaches.
Authors: Solaiman Tarafder; Joseph Gulko; Daniel Kim; Kun Hee Sim; Shawn Gutman; Jian Yang; James L Cook; Chang H Lee Journal: J Orthop Res Date: 2019-03-28 Impact factor: 3.494
Authors: Andrzej Brzezinski; Casey Imbergamo; William Pfaff; Rae Tarapore; Matthew Nasra; Michael Simon; Charles Gatt Journal: Arthrosc Sports Med Rehabil Date: 2022-02-11
Authors: M K Bartolo; E Provaggi; K K Athwal; S Newman; M A Accardi; D Dini; A Williams; A A Amis Journal: Knee Surg Sports Traumatol Arthrosc Date: 2021-10-19 Impact factor: 4.114