Biomechanical Study of Meniscal Repair Using Horizontal Sutures and Vertical Loop Techniques

Document Type : Original Article


Department of Orthopedic Surgery, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran


Background: Meniscus plays an important role in weight-bearing and energy absorption. Moreover, its function is optimal to maintain joint stability and congruous. Treatments for meniscus damage or meniscus tear include open or arthroscopic repair and meniscectomy. One of the most important factors that influence patients' recovery outcome is restoration technique. The purpose of this study was to compare the strength of recently new method of meniscus repair, submeniscal horizontal sutures, and single vertical loop suturing techniques in meniscus repair. Materials and Methods: An experimental study was conducted to study 12 ruptured medial meniscuses of bulls, which were divided into two groups of six meniscuses equally. In this study, submeniscal horizontal and vertical loop suturing techniques were compared based on their resistance to tensile forces and the stability of repaired gaps. Results: In this study, submeniscal horizontal and vertical loop knots were 104.3 ± 12.5 N and 110.7 ± 16.4 N, respectively. No significant difference was found between the two groups. To measure the stability of the gap, 95.4 ± 8.7 N tensile force was applied to submeniscal and 124.6 ± 11.7 N to vertical loop techniques. There was significantly different in gap stability between horizontal and vertical loop techniques in meniscal repair (P = 0.02). Conclusion: The results of this study indicate that knot resistance in submeniscal horizontal is similar to vertical loop resistance. The stability of the restored gap in vertical loop technique is more than submeniscal horizontal techniques. Vertical loop causes greater stability against tensile force.


Maffulli N, Longo UG, Campi S, Denaro V. Meniscal tears. Open Access J Sports Med 2010;1:45-54.  Back to cited text no. 1
Konan S, Haddad FS. Outcomes of meniscal preservation using all-inside meniscus repair devices. Clin Orthop Relat Res 2010;468:1209-13.  Back to cited text no. 2
Adams SB Jr., Peretti GM, Weinand C, Randolph MA, Gill TJ. Meniscal repair: Current strategies and the future of tissue engineering. Ortho J Harv Med Sch 2003;5:138-41.  Back to cited text no. 3
Barber FA, Herbert MA, Richards DP. Load to failure testing of new meniscal repair devices. Arthroscopy 2004;20:45-50.  Back to cited text no. 4
Dervin GF, Downing KJ, Keene GC, McBride DG. Failure strengths of suture versus biodegradable arrow for meniscal repair: An in vitro study. Arthroscopy 1997;13:296-300.  Back to cited text no. 5
Rankin CC, Lintner DM, Noble PC, Paravic V, Greer E. A biomechanical analysis of meniscal repair techniques. Am J Sports Med 2002;30:492-7.  Back to cited text no. 6
Rimmer MG, Nawana NS, Keene GC, Pearcy MJ. Failure strengths of different meniscal suturing techniques. Arthroscopy 1995;11:146-50.  Back to cited text no. 7
Navali AM, Aslani H. Clinical results of meniscal repair using submeniscal horizontal sutures. Arch Bone Jt Surg 2015;3:179-83.  Back to cited text no. 8
Rockborn P, Messner K. Long-term results of meniscus repair and meniscectomy: A 13-year functional and radiographic follow-up study. Knee Surg Sports Traumatol Arthrosc 2000;8:2-10.  Back to cited text no. 9
Song EK, Lee KB. Biomechanical test comparing the load to failure of the biodegradable meniscus arrow versus meniscal suture. Arthroscopy 1999;15:726-32.  Back to cited text no. 10
Sarimo J, Rantanen J, Tarvainen T, Härkönen M, Orava S. Evaluation of the second-generation meniscus arrow in the fixation of bucket-handle tears in the vascular area of the meniscus. A prospective study of 20 patients with a mean follow-up of 26 months. Knee Surg Sports Traumatol Arthrosc 2005;13:614-8.  Back to cited text no. 11
Kelly JD 4th, Ebrahimpour P. Chondral injury and synovitis after arthroscopic meniscal repair using an outside-in mulberry knot suture technique. Arthroscopy 2004;20:e49-52.  Back to cited text no. 12
Kotsovolos ES, Hantes ME, Mastrokalos DS, Lorbach O, Paessler HH. Results of all-inside meniscal repair with the FasT-fix meniscal repair system. Arthroscopy 2006;22:3-9.  Back to cited text no. 13
Boenisch UW, Faber KJ, Ciarelli M, Steadman JR, Arnoczky SP. Pull-out strength and stiffness of meniscal repair using absorbable arrows or ti-cron vertical and horizontal loop sutures. Am J Sports Med 1999;27:626-31.  Back to cited text no. 14
Post WR, Akers SR, Kish V. Load to failure of common meniscal repair techniques: Effects of suture technique and suture material. Arthroscopy 1997;13:731-6.  Back to cited text no. 15
Fantasia F, Potalivo G, Placella G, Fantasia L, Cerulli G. Meniscal sutures: Biomechanical study of “mulberry” and horizontal loop techniques. J Orthop Traumatol 2012;13:13-9.  Back to cited text no. 16
Kocabey Y, Taser O, Nyland J, Doral MN, Demirhan M, Caborn DN, et al. Pullout strength of meniscal repair after cyclic loading: Comparison of vertical, horizontal, and oblique suture techniques. Knee Surg Sports Traumatol Arthrosc 2006;14:998-1003.  Back to cited text no. 17
Stender ZC, Cracchiolo AM, Walsh MP, Patterson DP, Wilusz MJ, Lemos SE. Radial tears of the lateral meniscus-two novel repair techniques: A biomechanical study. Orthop J Sports Med 2018;6:2325967118768086.  Back to cited text no. 18