A Contact Pressure Analysis Comparing an All-Inside and Inside-Out Surgical Repair Technique for Bucket-Handle Medial Meniscus Tears

Daniel Cole Marchetti, Brian M. Phelps, Kimi D. Dahl, Erik L. Slette, Jacob D. Mikula, Grant J. Dornan, Gabriella Bucci, Travis Lee Turnbull, Steven B. Singleton

Research output: Contribution to journalArticlepeer-review

20 Scopus citations

Abstract

Purpose To directly compare effectiveness of the inside-out and all-inside medial meniscal repair techniques in restoring native contact area and contact pressure across the medial tibial plateau at multiple knee flexion angles. Methods Twelve male, nonpaired (n = 12), fresh-frozen human cadaveric knees underwent a series of 5 consecutive states: (1) intact medial meniscus, (2) MCL tear and repair, (3) simulated bucket-handle longitudinal tear of the medial meniscus, (4) inside-out meniscal repair, and (5) all-inside meniscal repair. Knees were loaded with a 1,000-N axial compressive force at 5 knee flexion angles (0°, 30°, 45°, 60°, 90°), and contact area, mean contact pressure, and peak contact pressure were calculated using thin film pressure sensors. Results No significant differences were observed between the inside-out and all-inside repair techniques at any flexion angle for contact area, mean contact pressure, and peak contact pressure (all P >.791). Compared with the torn meniscus state, inside-out and all-inside repair techniques resulted in increased contact area at all flexion angles (all P <.005 and all P <.037, respectively), decreased mean contact pressure at all flexion angles (all P <.007 and all P <.001, respectively) except for 0° (P =.097 and P =.39, respectively), and decreased peak contact pressure at all flexion angles (all P <.001, all P <.001, respectively) except for 0° (P =.080 and P =.544, respectively). However, there were significant differences in contact area and peak contact pressure between the intact state and inside-out technique at angles ≥45° (all P <.014 and all P <.032, respectively). Additionally, there were significant differences between the intact state and all-inside technique in contact area at 60° and 90° and peak contact pressure at 90° (both P <.005 and P =.004, respectively). Median values of intact contact area, mean contact pressure, and peak contact pressure over the tested flexion angles ranged from 498 to 561 mm2, 786 to 997 N/mm2, and 1,990 to 2,215 N/mm2, respectively. Conclusions Contact area, mean contact pressure, and peak contact pressure were not significantly different between the all-inside and inside-out repair techniques at any tested flexion angle. Both techniques adequately restored native meniscus biomechanics near an intact level. Clinical Relevance An all-inside repair technique provided similar, native-state-restoring contact mechanics compared with an inside-out repair technique for the treatment of displaced bucket-handle tears of the medial meniscus. Thus, both techniques may adequately decrease the likelihood of cartilage degeneration.

Original languageEnglish (US)
Pages (from-to)1840-1848
Number of pages9
JournalArthroscopy - Journal of Arthroscopic and Related Surgery
Volume33
Issue number10
DOIs
StatePublished - Oct 2017
Externally publishedYes

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

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