Document Title: Arnoczky-AJSM-Mar01.shtml
Article Title: Tensile fixation strengths of absorbable meniscal repair devices as a function of hydrolysis time -- An in vitro Experimental Study
Authors: Steven P Arnoczky, Michael Lavagnino, et al.
Publication: American Journal of Sports Medicine, Baltimore, Maryland
Date: Mar/Apr 2001
Volume 29, Number 2, pages 118-123

(Figures included. Reference-denoting numbers appear in the same point size as the document text.)

This article provides good insight into how the strength of various bioabsorbable meniscal repair devices decreases after time. The concerns of structure failure, along with additional concerns unique to barbed meniscal-repair devices, mean that suturing (via the inside-out technique or similar painstaking method) remains the best option. Intriguingly, the product (Bionx Meniscus Arrow) from the firm which funded this study (Bionx Implants), proved to be the absolute worst meniscal-repair device. Anyone with a meniscal tear would be well-advised to seek out a surgeon who is willing to diligently and carefully repair the meniscus by suturing (instead of trying to cut corners by deciding beforehand to merely excise the damaged tissue).

ABSTRACT

To determine the effect of hydrolysis time on the fixation strength of absorbable meniscal repair devices, adult bovine menisci were repaired with five devices and a suture. The ultimate tensile strength of the repair was then tested in six specimens immediately or after 6, 12, or 24 weeks of incubation at 37 deg C in a saline solution containing antibiotics, antimycotics, and protease inhibitors. Immediately after implantation the Bionx Meniscus Arrow had a significantly higher failure strength (57.7+/-13.8 N) than the Linvatec BioStinger (35.1+/-6.7 N), the Innovasive Clearfix screw (34.9 +/13 N), the Surgical Dynamics S-D-sorb staple (9.4 +/4.6 N), and the Mitek Meniscal Repair System (polydioxanone) (27.2+/-6.0 N). However, there was no significant difference between the Bionx Meniscus Arrow and a 2-0 polydioxanone vertical suture (51.6+/2.7 N). The polydioxanone-based implants demonstrated a significant decrease in failure strength at 12 and 24 weeks. Similarly, the Surgical Dynamics S.D-sorb staple lost all fixation strength by 24 weeks. The remaining devices showed no significant loss of failure strength over the 24-week period, suggesting that 24 weeks of hydrolysis does not adversely affect the ultimate holding power of poly L-lactide-based meniscal fixation devices.

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