AJSM - 2026-08-27 - Journal Article
Effect of Multiple Centralization Sutures on Meniscal Extrusion and Contact Pressures in a Cadaveric Model of Medial Meniscus Root Repair.
Andersen M, Tollefson LV, Ngobi J, Carlson MR, LaPrade CM, Fladberg B, Frihagen F, Inderhaug E, LaPrade RF
Topics
Key Takeaway
In a cadaveric PMMR repair model, combining all 3 centralization sutures reduced contact pressures at 0°, 30°, and 60° flexion and extrusion at 90° flexion, while a single MCL-border suture alone restored pressures only at full extension.
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Summary
This study tested whether the number and placement of centralization sutures (CSs) added to a nonanatomic PMMR repair affect meniscal extrusion and tibiofemoral contact pressures across 10 conditions in 9 cadaveric knees using 3D motion capture and pressure sensors. A single CS at the posterior MCL border reduced contact pressures at 0° and extrusion at 60°; the CS2+CS3 combination reduced pressures at 0°, 60°, and 120°; and all 3 CSs combined reduced pressures at 0°, 30°, and 60° and extrusion at 90°. No CS configuration produced medial contact pressures significantly different from the intact state, suggesting any CS addition partially restores compartment loading.
Key Limitation
The sample size of 9 specimens provides limited statistical power to detect differences between individual CS configurations, risking type II error for comparisons that trended but did not reach significance.
Original Abstract
BACKGROUND
Adding a centralization suture (CS) during repair of a posterior medial meniscus root (PMMR) tear may decrease meniscal extrusion and osteoarthritis progression. However, the number and optimal placement of CSs remain unclear.
HYPOTHESIS
Increasing numbers and changing localization of CSs would not influence the degree of postoperative extrusion or joint contact pressures.
STUDY DESIGN
Controlled laboratory study.
METHODS
Meniscal extrusion and tibiofemoral contact pressures were assessed using a 3-dimensional motion capture system and pressure sensors in 9 human cadaveric knees. A nonanatomic root repair was created to simulate persistent meniscal extrusion after a PMMR repair. Each knee was tested under 10 conditions: (1) intact, (2) PMMR tear, (3) root repair, (4) CS at the posterior border of the medial collateral ligament (MCL) (CS1), (5) CS midway between CS 1 and CS 3 (CS2), (6) CS at the midpoint between the MCL and posterior root attachment (CS3), and (7-10) combinations of these CSs (all CSs were in addition to the root repair). Analysis of variance testing was used for analyses of pressure data and extrusion measurements.
RESULTS
There was no significant difference in medial contact pressure between the intact state and the states with root repair in combination with any CS configuration ( P > .05). Contact pressures were reduced compared to the root repair state for CS1 alone at 0° ( P = .014); the combination of CS2 and CS3 at 0°, 60°, and 120° ( P ≤ .038); and the combination of all 3 CSs at 0°, 30°, and 60° of flexion ( P ≤ .037). Extrusion was reduced compared to the root repair state for CS1 alone at 60° ( P = .043) and all 3 CSs combined at 90° of flexion ( P < .009).
CONCLUSION
A single CS placed at the posterior border of the MCL decreased medial contact pressures at 0° and reduced extrusion at 60° of flexion. The combined use of 2 CSs placed at the posteromedial meniscus junction reduced contact pressures across multiple flexion angles (0°, 60°, and 120°). The combination of 3 CSs reduced contact pressures at 0°, 30°, and 60° and extrusion at 90°. Until clinical studies are conducted, the benefits of additional CSs should be weighed against time and cost.
CLINICAL RELEVANCE
These findings should guide surgeons on the optimal number and placement of CSs to minimize meniscal extrusion and restore medial compartment contact pressures.