- Pasic N, Storaci H, Guzman R, et al. A Biomechanical Comparison of All-Inside Versus Transtibial Meniscus Root Repair Techniques. The American Journal of Sports Medicine. 2023;0(0). doi:10.1177/03635465231179960
Meniscal root tears are associated with cartilage damage, early degenerative change and a high conversion rate to total joint arthroplasty. The aim of this study (A Biomechanical Comparison of All-Inside Versus Transtibial Meniscus Root Repair Techniques, doi: 10.1177/03635465231179960) was to evaluate the biomechanical properties of the all-inside meniscus root repair procedure and compare it with the transtibial technique.
In All-Inside Meniscus Root Repair applications, the access route is via smaller arthroscopic incisions. This means that the repair instruments are placed entirely within the joint without the need for additional incisions. In contrast, with transtibial medial meniscus root repair, an incision is made at the front of the knee to gain access to the affected area.
The all-inside method offers the advantage of smaller incisions, less post-operative pain, faster recovery and a reduced risk of complications. However, this method can be technically more challenging for certain meniscal tears. The transtibial method allows better visibility and access to the meniscal root, but is associated with larger incisions and usually a longer recovery time.
The skin, subcutaneous tissue, quadriceps muscles, patella and patellar tendon were removed from nine paired knee joints of deceased patients, leaving the capsule intact. Pressure sensors were inserted and specimens were subjected to compressive loading to measure peak loads, average loads and femorotibial contact area in the medial and lateral compartments.
The tests were performed as static compression tests with the knee flexed at 0° flexion. The compression tests were performed in three conditions: intact meniscus, severed meniscal root and after meniscal root repair using an all-inside repair technique. In addition, tests were performed on nine pairs of cadaver knees to compare stiffness and maximum failure load between the all-inside and transtibial meniscal root repair techniques.
In the medial compartment, significant increases in median peak and average loads were seen in the severed root condition compared to the intact condition. All-inside meniscal root repair restored median peak and average loads close to those of the intact meniscus. In the lateral compartment, significant increases in median peak and average loads were also observed in the severed root condition compared with the intact condition.
All-inside meniscal root repair restored median peak and mean strains that were not significantly different from the intact state. There was no difference between the repair techniques in terms of failure load. The transtibial meniscal root repair had significantly higher stiffness compared to the all-inside meniscal root repair technique.
In summary, the all-inside meniscal root repair was able to significantly reduce the median peak and average loads to values of the intact meniscus with the knee in extension. Compared with the transtibial meniscal root repair technique, the all-inside repair showed lower stiffness and similar failure load. In clinical routine, however, the results depend significantly on the experience of the surgeon.