What kind of sutures are used in meniscus repair?

Suture Types Used in Meniscus Repair

For meniscus repair, nonabsorbable braided sutures are recommended as the primary choice due to their lower clinical failure rates and better long-term outcomes compared to absorbable sutures. 1

Suture Material Options

Nonabsorbable Sutures

• Nonabsorbable braided sutures (such as Ethibond 2-0) are preferred for meniscus repair due to their ability to provide longer and more stable fixation, allowing for more complete maturation and remodeling of the meniscus 1
• Clinical studies demonstrate significantly lower failure rates with nonabsorbable sutures (0% failure) compared to absorbable sutures (18% failure) 1
• Permanent sutures maintain their tensile strength throughout the healing process, which is particularly important given the slow healing rate of meniscal tissue 1, 2

Absorbable Sutures

• Absorbable options include monofilament PDS 2-0 and rapidly-absorbing polyglactin 910 (VICRYL RAPIDE) 3, 2
• While absorbable sutures show comparable initial healing rates to nonabsorbable sutures (93.7% vs 96.8%), they have been associated with higher long-term clinical failure rates 4, 1
• One potential advantage of absorbable sutures is a lower incidence of additional tears (2.5% vs 9.6% with nonabsorbable) in cases with concomitant ACL reconstruction 4

Suture Size and Configuration

• Size 2-0 to 0 USP sutures are typically used for meniscal repairs 2
• Vertical mattress sutures demonstrate superior resistance to displacement compared to horizontal mattress sutures 3
• Vertical sutures show 100% suture failure mode, while horizontal sutures show 50% suture failure and 50% tissue failure, indicating better tissue holding with vertical configuration 3

Repair Techniques

• Inside-out technique: Sutures are introduced using a needle through a guide cannula from outside the joint through the meniscus and joint capsule 2
• Outside-in technique: Sutures are introduced from outside the joint through the meniscus base using a cannulated needle 2
• All-inside technique: Suture loops are passed through the meniscal tear and knotted within the joint using a posterior arthroscopy approach 2, 5
• The 2-simple-stitches (TSS) method is preferred for meniscal root repairs as it allows the least displacement of the meniscus root 5

Biomechanical Considerations

• Under cyclic loading conditions, both suture types (absorbable and nonabsorbable) show similar ultimate failure loads (approximately 60N) 3
• A gap appears between meniscal margins within the first loading cycles regardless of suture type or material 3
• Vertical sutures provide superior resistance to tissue failure compared to horizontal sutures under cyclic loading 3

Clinical Outcomes

• Healing rates for isolated meniscal tears in stable knee joints range from 50-75% 2
• With simultaneous ACL reconstruction, healing rates improve to >75% 2
• In unstable knee joints, healing rates drop to <50%, highlighting the importance of addressing joint stability 2

Rehabilitation Considerations

• For small tears with one suture: Full weight bearing without a brace may be allowed 2
• For tears with two sutures: Partial weight bearing for 4 weeks without a brace is recommended 2
• For large tears with three to four sutures: Partial weight bearing up to 20 kp for 6 weeks and restricted knee motion in a brace up to 0/0/60 degrees is advised 2

The choice between absorbable and nonabsorbable sutures should be made based on the specific tear characteristics, location, and concomitant procedures, but the evidence strongly favors nonabsorbable sutures for isolated meniscal repairs due to their superior long-term outcomes and lower clinical failure rates.