The influence of suture material on the strength of horizontal mattress suture configuration for meniscus repair

Purpose: Comparison of the mechanical characteristics of meniscal repair fixation using horizontal sutures and six different sutures under submaximal cyclic and load to failure test conditions may aid physicians in selecting a suture type.

Methods: A 2-cm long anteroposterior vertical longitudinal incision was created in six groups of bovine medial menisci. Lesions were repaired using a No. 2 suture either composed of polyester or polyester and ultra high-molecular weight polyethylene (UHMWPE), or UHMWPE and polydioxanone or pure UHMWPE. Endpoints included ultimate failure load (N), pull-out stiffness (N/mm), pull-out displacement (mm), cyclic displacement (mm) after 100cycles, after 500cycles, and mode of failure.

Results: Polyester suture had lower ultimate load than all groups except the suture composed of polyester and UHMWPE (P<.05). Pure UHMWPE suture had higher ultimate failure load than sutures composed of either polyester or polyester plus UHMWPE (P<.05). Predominant failure mode was suture cutting through the meniscus for the groups except for polyester suture which failed by suture rupture.

Conclusion: Under cyclic loading conditions in bovine meniscus, braided polyester suture fixation provided lower initial fixation strength than fixation with various high strength sutures composed of pure UHMWPE or a combination of absorbable monofilament polydioxanone and UHMWPE, except for combination of polyester and UHMWPE sutures.

Clinical relevance: Present study does not support the usage of the braided polyester sutures instead of high strength sutures composed either partially or totally of ultra-high molecular weight polyethylene for the horizontal suture configuration of meniscus repair.