Biomechanical analysis of four different meniscus suturing techniques for posterior meniscal root pull‐out repair: A human cadaveric study

Abstract Purpose To compare the biomechanical properties of the slip‐knot technique with three other transtibial pullout suture repair constructs for meniscal root tears. Method Thirty‐two fresh‐frozen cadaveric menisci were randomly allocated to four meniscus‐suture fixation constructs: Two simple‐sutures (TSS), two slip‐knot (TSK) sutures, two cinch‐loop (TCL) sutures, and two modified Mason–Allen (TMMA) sutures. Cyclic loading from 5 to 20 N was conducted for 1000 cycles at 0.5 Hz, and then loaded to failure at 0.5 mm/s. Parametric data (displacement during cyclic loading, ultimate load, yield load, and displacement at failure) were analysed using a one‐way analysis of variance (ANOVA), whereas nonparametric data (stiffness) were analysed using the Kruskal–Wallis test. Results After 1000 cycles, the TCL construct significantly displaced the most (mean ± SD, 6.78 ± 1.32 mm; p 0.05) and the other three groups (TSS, 94.65 ± 25.33 N; TMMA, 168.38 ± 23.24 N; TCL, 170.54 ± 57.32 N); however, it exhibited the least displacement (5.53 ± 1.25 mm) which was significantly shorter than those of the TCL (11.82 ± 4.25 mm, p < 0.001) and TMMA (9.53 ± 2.18 mm, p = 0.03) constructs. No significant difference in stiffness was observed among the four meniscus‐suture constructs. Conclusion The slip‐knot technique has proven to be a simple, yet robust and stable meniscal root fixation option; moreover, it exhibited superiority over the more complex modified Mason–Allen suture construct in resisting displacement at the ultimate failure load. Level of Evidence Not applicable.