Bone Plug versus Suture Fixation of the Posterior Horn in Medial Meniscal Allograft Transplantation A Biomechanical Study

This study was performed to determine if a meniscal allograft with attached bone plug and suture offers superior fixation when compared to allograft affixed with suture alone through a bony tunnel. Seven pairs of human cadaver proximal tibia specimens were obtained. The specimens were then randomly assigned to either Group 1 (suture alone) or Group 2 (bone plug plus suture). All Group 1 specimens had the meniscus detached at the bony insertion of the anterior and posterior horns, with two No. 2 Ethibond sutures placed at the posterior root insertion. All Group 2 specimens had a posterior horn with a bone plug and two No. 2 Ethibond sutures. Both groups had their respective sutures passed through a 7 mm tibial tunnel and secured over a screw and post on the proximal tibia. The specimens were then loaded to failure. The mean failure load for Group 1 was 111.8 N (SD: 21 N) and for Group 2 was 112 N (SD: 32 N). Based on the Wilcoxon Rank-Sum analysis, the two groups were not significantly different. This study demonstrated no difference in the mean pullout strength of medial meniscal allograft posterior horn fixation between the two groups. This biomechanical cadaveric study demonstrated that it may not be necessary to use an attached bone plug for medial meniscal transplant fixation, as using suture alone will suffice. The choice of using suture alone for the posterior horn meniscal attachment eases the technique of surgery when compared to using a bone plug plus suture.