Abstract
Background:
Prior biomechanical research has shown that pediatric meniscal tissue responds differently to repair techniques compared to adult tissue. While the Mason-Allen (MA) suture pattern demonstrated slightly superior biomechanical performance compared to the Double Luggage-Tag (DLT) in adult cadaveric studies, similar studies have not been performed with pediatric specimens. This study’s purpose is to determine the superior suture technique for pediatric posterior meniscus root repairs.
Hypothesis:
There will be no significant difference in ultimate failure load (N) or displacement after cyclic loading (mm) between the DLT and MA suture constructs for posterior meniscus root repairs in pediatric cadaver tissue.
Methods:
We resected 10 pediatric menisci from the tibial plateau to simulate a root avulsion. Each meniscus was randomized to either DLT or MA repair. The anterior horn was clamped to the Instron 5944 load-testing system, and the suture limbs were tied to the load applicator of the Instron. Each meniscus was cyclically preconditioned and loaded for 500 cycles of 10-30 N at 0.5 Hz to determine cyclic displacement. Following a 30-minute rest period, each meniscus was pulled to failure to determine the ultimate failure load of the construct.
Results:
The mean ultimate failure load of the DLT construct was 158.2 N (± 64.66), which was not statistically different from the MA construct at 164.0 N (± 74.62) (p = 0.899). The mean displacement following cyclic loading was 2.6 mm (± 0.99) for the DLT construct and 2.6 mm (± 2.27) for the MA construct (p = 1.00).
Conclusion:
While the MA configuration has demonstrated superior performance in adult specimens, the DLT and MA constructs exhibited comparable biomechanical outcomes in pediatric menisci. The DLT’s shorter learning curve and reduced operative time may make it a favorable technique for transtibial pull-out or joint-level posterior meniscal root repair in pediatric patients. This construct may be especially advantageous given the smaller anatomical dimensions of skeletally immature knees, as DLT may require less joint-space opening for repair.
