Meniscal root suturing techniques: Implications for root fixation

Background: Meniscal root tears have attracted increasing interest in recent years. Fixation is an important factor for rehabilitation and avoidance of early failure. Suture fixations have been the most commonly used techniques. The current study aimed to evaluate the maximum failure load of the native meniscal roots (anteromedial, posteromedial, anterolateral, and posterolateral) and of 3 commonly used meniscal root fixation techniques (2 simple stitches, modified Kessler stitch, and loop stitch).Hypotheses: (1) There will be no difference in maximum failure load between the native meniscal roots. (2) The loop stitch will sustain the greatest maximum load to failure, followed by the modified Kessler stitch and the 2 simple stitches. (3) The maximum failure load of the native meniscal roots will not be restored by the tested fixation methods.Study Design: Controlled laboratory study.Methods: The maximum failure load of the 4 human native meniscal roots was evaluated using 64 human meniscal roots. Additionally, the maximum failure load of the 3 fixation techniques was evaluated on 24 meniscal roots: (1) 2 simple stitches, (2) modified Kessler stitch, and (3) loop stitch using a suture shuttle.Results: The average maximum failure load of the native meniscal roots was 594 ± 241 N (anterolateral: 692 ± 304 N; posterolateral: 648 ± 140 N; anteromedial: 407 ± 180 N; posteromedial: 678 ± 200 N). The anteromedial root was significantly weaker than the posterolateral and posteromedial roots (P =.04 and P =.01, respectively). Regarding fixation techniques, the maximum failure load of the 2 simple stitches was 64.1 ± 22.5 N, the modified Kessler stitch was 142.6 ± 33.3 N, and the loop was 100.9 ± 41.6 N. None of the fixation techniques recreated the strength of the native roots.Conclusion: The native anterolateral root was the strongest meniscal root, and the anteromedial root was the weakest meniscal root. Regarding primary fixation strength, the modified Kessler stitch was the strongest technique compared with the loop and the 2 simple stitches.Clinical Relevance: None of our tested fixation methods restored the strength of native meniscal roots. Thus, rehabilitation after meniscal root fixation should proceed cautiously.