Three single loops enhance the biomechanical behavior of the transtibial pull-out technique for posterior meniscal root repair.

Purpose: To investigate the effect of applying an additional suture to enhance the biomechanical behavior of the suture–meniscus construct used during the transtibial pull- out repair technique. Methods: A total of 20 fresh-frozen porcine tibiae with intact medial menisci were used. In one half of all speci- mens (N = 10), two non-absorbable sutures were passed directly over the meniscal root from the tibia side of the meniscus to the femoral side (2SS). In other ten specimens, three sutures were passed over the meniscal root (3SS). All specimens were subjected to cyclic loading followed by load-to-failure testing. Displacement of the construct was recorded at 100, 500, and 1000 cycles. Further, stiffness (500–1000 cycles) and ultimate load and modes of failure of the suture–meniscus construct were also recorded. Results: There was no statistically significant difference between the Group 2SS and Group 3SS at the 1st (1.6±0.7vs1.4±0.4mm)andthe100thcycle(2±0.7 vs 1.8 ± 0.4 mm). At 500 and 1000 cycles, the 2SS fixa- tion technique resulted in significantly more displacement than the 3SS fixation technique (2.8 ± 0.6 vs 2.3 ± 0.5 mm; 3.1 ± 0.7 vs 2.5 ± 0.5 mm) (p\0.05). No differences between two groups were noted concerning ultimate load to failure and stiffness (500–1000 cycles). Conclusion: Three single sutures technique provided superior biomechanical properties compared with the two single sutures technique during the conducted fatigue tests. Clinical relevance Applying three simple stitches during meniscal root repair might be beneficial for healing of the posterior meniscal root, potentially reducing the post-op- erative immobilization time.