Cyclic testing of meniscal sutures

Suturing the meniscus has become a standard procedure for repairable tears. Studies investigating the outcome of meniscal sutures report a considerable rate of failures. Regarding the indications, which have been extended to the avascular zones, and regarding some accelerated rehabilitation protocols, the need for further in vitro investigations has become obvious. The aim of this study was to compare different meniscal suture types (vertical and horizontal mattress sutures) and materials (absorbable monofilament PDS 2-0, and nonabsorbable braided Ethibond 2-0 [Ethicon, Somerville, NJ]) under standard and cyclic loading conditions. Testing was performed on medial porcine menisci. In group A, specimens were tested to failure at a cross-head speed of 50 mm/minute. In group B, cyclic testing (100 cycles) was performed first within different load intervals (5 to 20 N and 5 to 40 N). Finally, the specimens were loaded until failure. In both groups, the failure loads were recorded and the failure modes were analyzed. In group A, there was no difference between suture type or suture material, with a mean failure load of 60 N. The failure modes were significantly different for vertical (100% suture failure) and horizontal sutures (50% suture failure) (P < .0001). In group B, 13% of the sutures failed under cyclic loading (7 with 40-N load, 1 with 20-N load). The gap of the sutured tear that appeared within the first load cycles was broader in horizontal sutures (P < .001). During the first cycles, the thread cut through the meniscus tissue and disappeared from the surface (partial tissue failure). There was no difference according to suture material. The ultimate failure loads after cyclic loadings did not differ from the values of group A. These results show that meniscal sutures may fail under repetitive loading conditions and that a gap appears between the meniscal margins within the first loading cycles irrespective of the suture type and suture material used. The appearance of the gap and suture disappearance on the meniscal surface because of partial tissue failures (which were more pronounced in the horizontal sutures) confirmed the superior resistance of meniscal tissue to vertical sutures.