Biomechanical Properties of Posterior Meniscal Root Repairs: A Systematic Review.

Purpose: To systematically review the literature regarding the biomechanical properties of various meniscal root repair techniques.

Methods: A systematic review of multiple databases was performed. The inclusion criteria included English language, studies relevant to meniscal root repairs, studies comparing 2 or more different discrete techniques, posterior root repairs, controlled laboratory studies, and human cadaveric or animal studies. Abstracts, case reports, cohort studies, case-control studies, systematic reviews and meta-analyses, and studies of meniscal body repairs were excluded.

Results: Seventeen controlled laboratory studies were included for final analysis. There is no consensus on biomechanical superiority between transtibial pullout repair (TPR) and suture anchor repair. For TPR, there is no significant difference between 1 and 2 tibial tunnels. Nonanatomic repairs result in significantly lower joint surface contact areas and higher contact pressures, but suture placement farther from the root results in higher maximum load to failure. Two-suture repair has a greater maximum load to failure than 1-suture repair. Use of more than 2 sutures has diminishing returns. The modified Mason-Allen suture configuration is superior to a simple suture configuration, but there is no consensus regarding the superiority or feasibility of more complex sutures. There is no consensus on the superiority of a single suture material or shape.

Conclusions: Anatomic meniscal root repairs with either TPR or suture anchor repair have better joint surface contact pressures and contact surface areas than nonanatomic repairs. The use of 2 sutures results in better fixation than 1 suture. There is evidence that the modified Mason-Allen suture configuration is superior to a simple suture configuration in a TPR, although the benefits of more complicated configurations are unclear.

Clinical Relevance: This study suggests that, in general, more complex sutures exhibit higher maximum loads. Increasing the number of sutures to up to 2 of the same configuration also increases the maximum load.