Gapping phenomenon of longitudinal meniscal tears


      Objective. To investigate the gapping behaviour of longitudinal meniscal tears.
      Design. The gap size of longitudinal meniscal tears was measured in porcine knee joints under various joint loading conditions.
      Background. Many meniscal fixation implants have low pull out forces. However, it is unknown if these forces are less than the forces the implants must resist in vivo. It is also unknown if gapping occurs in longitudinally torn menisci and what joint loads induce gapping.
      Methods. Longitudinal tears were set in the medial menisci of eight porcine knee joints. To observe the tears an opaque placeholder of the same shape as the original articular surface replaced the medial tibial plateau. The knees were exposed to flexion-extension cycles in a loading and motion simulator under 30 and 200 N axial joint load without external moments, under tibial rotation moments, varus or valgus moments, and combined moments. For each load condition the maximum gap of the tear was registered.
      Results. Maximum gapping (1.59 mm, SD 0.47) occurred in the 3 cm tear at 200 N axial joint load under the combination of a valgus and external rotation moment. An internal tibial rotation moment produced the smallest gaps in tears of any length and at any axial joint load.
      Conclusions. The maximum gap size found in this study and the previously published pull out stiffnesses of meniscal fixation implants reveal maximum forces on the implant in vivo of only 8.4 N. This explains why meniscal tears fixed with implants of low pull out strength can heal.Relevance
      The current study shows that moderate joint loads only lead to small gaps of meniscal tears. Clinically, this means that fixation implants of low pull out strength are not in danger of failure in a normal rehabilitation regimen.


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        • Albrecht-Olsen P.
        • Kristensen G.
        • Burgaard P.
        • Joergensen U.
        • Toerholm C.
        The arrow versus horizontal suture in arthroscopic meniscus repair. A prospective randomized study with arthroscopic evaluation.
        Knee Surg. Sports Traumatol. Arthrosc. 1999; 7: 268-273
        • Albrecht-Olsen P.
        • Lind T.
        • Kristensen G.
        • Falkenberg B.
        Failure strength of a new meniscus arrow repair technique: biomechanical comparison with horizontal suture.
        Arthroscopy. 1997; 13: 183-187
        • Asik M.
        • Sener N.
        Failure strength of repair devices versus meniscus suturing techniques.
        Knee Surg. Sports Traumatol. Arthrosc. 2002; 10: 25-29
        • Aspden R.M.
        • Yarker Y.E.
        • Hukins D.W.
        Collagen orientations in the meniscus of the knee joint.
        J. Anat. 1985; 140: 371-380
        • Barber F.A.
        • Herbert M.A.
        Meniscal repair devices.
        Arthroscopy. 2000; 16: 613-618
        • Becker R.
        • Schröder M.
        • Starke C.
        • Urbach D.
        • Nebelung W.
        Biomechanical investigations of different meniscal repair implants in comparison with horizontal sutures on human meniscus.
        Arthroscopy. 2001; 17: 439-444
        • Boenisch U.W.
        • Faber K.J.
        • Ciarelli M.
        • Steadman J.R.
        • Arnoczky S.P.
        Pull-out strength and stiffness of meniscal repair using absorbable arrows or Ti-Cron vertical and horizontal loop sutures.
        Am. J. Sports Med. 1999; 27: 626-631
        • Dervin G.F.
        • Downing K.J.
        • Keene G.C.
        • McBride D.G.
        Failure strengths of suture versus biodegradable arrow for meniscal repair: an in vitro study.
        Arthroscopy. 1997; 13: 296-300
        • Dürselen L.
        • Claes L.
        • Kiefer H.
        The influence of muscle forces and external loads on cruciate ligament strain.
        Am. J. Sports Med. 1995; 23: 129-136
        • Dürselen L.
        • Hehl G.
        • Simnacher M.
        • Kinzl L.
        • Claes L.
        Augmentation of a ruptured posterior cruciate ligament provides normal knee joint stability during ligament healing.
        Clin. Biomech. 2001; 16: 222-228
        • Dürselen L.
        • Schneider J.
        • Galler M.
        • Claes L.E.
        • Bauer G.
        Cyclic joint loading can affect the initial stability of meniscal fixation implants.
        Clin. Biomech. 2003; 18: 44-49
        • Jaspers P.
        • de Lange A.
        • Huiskes R.
        • van Rens T.J.
        The mechanical function of the meniscus, experiments on cadaveric pig knee-joints.
        Acta Orthop. Belg. 1980; 46: 663-668
        • Joshi M.D.
        • Suh J.K.
        • Marui T.
        • Woo S.L.
        Interspecies variation of compressive biomechanical properties of the meniscus.
        J. Biomed. Mater. Res. 1995; 29: 823-828
        • Kirsch L.
        • Kohn D.
        • Glowik A.
        Forces in medial and lateral meniscus sutures during knee extension––an in vitro study.
        J. Biomech. 1999; : 104
        • Kohn D.
        • Siebert W.
        Meniscus suture techniques: a comparative biomechanical cadaver study.
        Arthroscopy. 1989; 5: 324-327
        • Messner K.
        • Gao J.
        The menisci of the knee joint. Anatomical and functional characteristics, and a rationale for clinical treatment.
        J. Anat. 1998; 193: 161-178
        • Müller W.
        The Knee––Form, Function and Ligament Reconstruction.
        Springer, Heidelberg1983
        • Rimmer M.G.
        • Nawana N.S.
        • Keene G.C.
        • Pearcy M.J.
        Failure strengths of different meniscal suturing techniques.
        Arthroscopy. 1995; 11: 146-150
        • Seil R.
        • Kohn D.
        Meniscus reconstruction. Established and innovative methods.
        Unfallchirurg. 2001; 104: 274-287
        • Song E.K.
        • Lee K.B.
        Biomechanical test comparing the load to failure of the biodegradable meniscus arrow versus meniscal suture.
        Arthroscopy. 1999; 15: 726-732
        • Thompson W.O.
        • Thaete F.L.
        • Fu F.H.
        • Dye S.F.
        Tibial meniscal dynamics using three-dimensional reconstruction of magnetic resonance images.
        Am. J. Sports Med. 1991; 19 (discussion 215–216): 210-215