Meta-analysis on biomechanical properties of meniscus repairs: are devices better than sutures?

• Published in: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Vol. 23; no. 1; pp. 83 - 89
• Main Authors: M. Buckland, Daniel, Sadoghi, Patrick, Wimmer, Matthias D., Vavken, Patrick, Pagenstert, Geert I., Valderrabano, Victor, Rosso, Claudio
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-01-2015; Springer Nature B.V
• Subjects: Absorbable Implants; Biomechanical Phenomena; Biomechanics; Bone surgery; Cartilage; Hospitals; Humans; Knee; Medicine; Medicine & Public Health; Menisci, Tibial - surgery; Meta-analysis; Orthopedics; Polyethylene Terephthalates; Stress, Mechanical; Surgeons; Suture Techniques - instrumentation; Sutures; Tensile Strength; Wound Healing; United States > US; Germany; Biomechanics; Load-to-failure; Stiffness; Meniscus; Repair; Devices
• ISSN: 0942-2056; 1433-7347
• DOI: 10.1007/s00167-014-2966-9

Purpose
Meniscal repair devices have been extensively tested during the past decades as reported in the literature. Reviewing the different meniscal repair devices and sutures with their respective biomechanical properties.
Methods
For this meta-analysis, we conducted a systematic online search using PubMed, EMBASE, CCTR, and CINAHL using the search terms
Meniscus OR Meniscal AND Biomechanics AND Repair)
. Load-to-failure (LtF), stiffness, and cyclic outcome measures were extracted independently and in duplicate. The systematic search revealed 841 manuscripts in total. After exclusion of duplicates and irrelevant publications, 41 studies remained for final analysis. The studies were published in English and German from 1995 to 2013. Due to differing cyclic force protocols, cyclic outcomes had to be excluded.
Results
Overall, sutures had a higher LtF [suture: 87.7 ± 0.3 N (weighted mean ± standard error), device: 56.3 ± 0.1 N] and stiffness (suture: 8.9 ± 0.04 N/mm, device: 8.6 ± 0.04 N/mm) than devices, both
p
 < 0.05. In LfT testing, PDS 0 Vertical (145.0 ± 8.1 N), OrthoCord 2-0 (143.6 ± 11.3 N), and Ethibond No 0 Vertical (133.4 ± 7.7 N) were the strongest sutures and Meniscal Viper (140.9 ± 5.1 N), MaxFire Vertical (136.2 ± 11.3 N), and FasT-Fix Vertical (115.2 ± 1.6 N) were the strongest devices. Second-generation devices were significantly stronger and stiffer than first-generation devices (
p
 < 0.001).
Clinical relevance
Suture repair remains the gold standard with a vertically oriented suture configuration showing superior LtF values compared to a horizontal configuration. Nevertheless, some meniscal repair devices have similar biomechanical properties to suture repairs. Both suture repairs and devices have a place in meniscal restoration.
Level of evidence
None, meta-analysis of controlled laboratory studies.