Inside-Out or Outside-In Suturing Should Not Be Considered the Standard Repair Method for Radial Tears of the Midbody of the Lateral Meniscus: A Systematic Review and Meta-Analysis of Biomechanical Studies

Eduard Alentorn-Geli; J. H. James Choi; Joseph J. Stuart; Alison P. Toth; William E. Garrett; Dean C. Taylor; Claude T. Moorman III

doi:10.1055/s-0035-1570113

The Journal of Knee Surgery, Table of Contents

J Knee Surg 2016; 29(07): 604-612
DOI: 10.1055/s-0035-1570113

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Inside-Out or Outside-In Suturing Should Not Be Considered the Standard Repair Method for Radial Tears of the Midbody of the Lateral Meniscus: A Systematic Review and Meta-Analysis of Biomechanical Studies

Authors

Eduard Alentorn-Geli

¹Duke Sports Sciences Institute, Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
J. H. James Choi

¹Duke Sports Sciences Institute, Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
Joseph J. Stuart

¹Duke Sports Sciences Institute, Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
Alison P. Toth

¹Duke Sports Sciences Institute, Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
William E. Garrett

¹Duke Sports Sciences Institute, Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
Dean C. Taylor

¹Duke Sports Sciences Institute, Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
Claude T. Moorman III

¹Duke Sports Sciences Institute, Department of Orthopaedic Surgery, Duke University, Durham, North Carolina

Abstract

The purpose was to evaluate which meniscal repair technique for radial tears of the midbody of the lateral meniscus demonstrates the best biomechanical properties. An electronic literature search was conducted using PubMed, EMBASE, CINAHL, and ScienceDirect databases. Biomechanical studies investigating the repair characteristics of radial tears in the midbody of the lateral meniscus were included. After appropriate screening, a total of 54 studies were reviewed in detail (full text), and 6 met inclusion criteria. The most common cause of exclusion was the investigation of longitudinal tears. Only two studies could be meta-analyzed. Stiffness was significantly higher for all-inside compared with inside-out repair techniques (p = 0.0009). No significant differences were observed between both suture methods for load to failure (p = 0.45). However, both studies used different all-inside devices and suture constructs. No clear conclusions can be drawn from the comparison of both types of repairs for displacement, site of failure, or contact pressure changes. Overall, there are no conclusive data to suggest that inside-out or outside-in suture repair has better load to failure or stiffness, less displacement, or different site of failure compared with all-inside repair. According to biomechanical data, it is under surgeon's preference to elect one repair technique over the other.

Keywords

lateral meniscus - meniscal repair - radial tear - biomechanics

Full Text

References

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