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Publikation Increased construct stiffness with meniscal repair sutures and devices increases the risk of cheese-wiring during biomechanical load-to-failure testing(SAGE, 15.06.2021) Müller, Sebastian; Schwenk, Tanja; de Wild, Michael; Dimitrou, Dimitris; Rosso, ClaudioBackground: Cheese-wiring, the suture that cuts through the meniscus, is a well-known issue in meniscal repair. So far, contributing factors are neither fully understood nor sufficiently studied. Hypothesis/purpose: To investigate whether the construct stiffness of repair sutures and devices correlates with suture cut-through (cheese-wiring) during load-to-failure testing. Study design: Controlled laboratory study. Methods: In 131 porcine menisci, longitudinal bucket-handle tears were repaired using either inside-out sutures (n = 66; No. 0 Ultrabraid, 2-0 Orthocord, 2-0 FiberWire, and 2-0 Ethibond) or all-inside devices (n = 65; FastFix360, Omnispan, and Meniscal Cinch). After cyclic loading, load-to-failure testing was performed. The mode of failure and construct stiffness were recorded. A receiver operating characteristic curve analysis was performed to define the optimal stiffness threshold for predicting meniscal repair failure by cheese-wiring. The 2-tailed t test and analysis of variance were used to test significance. Results: Loss of suture fixation was the most common mode of failure in all specimens (58%), except for the Omnispan, which failed most commonly because of anchor pull-through. The Omnispan demonstrated the highest construct stiffness (30.8 ± 3.5 N/mm), whereas the Meniscal Cinch (18.0 ± 8.8 N/mm) and Ethibond (19.4 ± 7.8 N/mm) demonstrated the lowest construct stiffness. The Omnispan showed significantly higher stiffness compared with the Meniscal Cinch (P < .001) and Ethibond (P = .02), whereas the stiffness of the Meniscal Cinch was significantly lower compared with that of the FiberWire (P = .01), Ultrabraid (P = .04), and FastFix360 (P = .03). While meniscal repair with a high construct stiffness more often failed by cheese-wiring, meniscal repair with a lower stiffness failed by loss of suture fixation, knot slippage, or anchor pull-through. Meniscal repair with a stiffness >26.5 N/mm had a 3.6 times higher risk of failure due to cheese-wiring during load-to-failure testing (95% CI, 1.4-8.2; P < .0001). Conclusion: Meniscal repair using inside-out sutures and all-inside devices with a higher construct stiffness (>26.5 N/mm) was more likely to fail through suture cut-through (cheese-wiring) than that with a lower stiffness (≤26.5 N/mm). Clinical relevance: This is the first study investigating the impact of construct stiffness on meniscal repair failure by suture cut-through (cheese-wiring).01A - Beitrag in wissenschaftlicher ZeitschriftPublikation Investigation of structural resorption behavior of biphasic bioceramics with help of gravimetry, μCT, SEM, and XRD(07.05.2015) de Wild, Michael; Molenberg, Aart; Amacher, Fabienne; Chris, BradburyResorbable bone substitute materials are widely used for bone augmentation after tumor resection, parallel to implant placement, or in critical size bone defects. In this study, the structural dissolution of a biphasic calcium phosphate bone substitute material with a hydroxyapatite (HA)/tricalcium phosphate (ß-TCP) ratio of 60/40 was investigated by repeatedly placing porous blocks in EDTA solution at 37°C. At several time points, the blocks were investigated by SEM, µCT, and gravimetry. It was found that always complete 2–3 µm sized grains were removed from the structure and that the ß-TCP is dissolved more rapidly. This selective dissolution of the ß-TCP grains was confirmed by XRD measurements. The blocks were eroded from the outside toward the center. The structure remained mechanically stable because the central part showed a delayed degradation and because the slower dissolving HA grains preserved the integrity of the structure.01A - Beitrag in wissenschaftlicher Zeitschrift
