Suture Interval Spacing in Meniscal Repair—Aim for ≤7 mm: A Biomechanical Study: ISAKOS Albert Trillat Award 2025

Background: The resistance to gap development under repetitive loading influences the probability of meniscal healing after meniscal repair. The optimal meniscal suture interval spacing for repairing longitudinal meniscal tears is poorly understood. This study aimed to investigate the effect of varying suture interval spacings on the biomechanical properties of vertical meniscal repairs. Hypothesis: There is a critical meniscal suture interval spacing beyond which the gap development during cycling loading increases and the stiffness of the construct decreases. Study Design: Controlled laboratory study. Methods: In 50 bovine menisci, complete vertical circumferential meniscal tears were created. All lesions were repaired using two 2-0 braided sutures with the vertical mattress inside-out technique. Five suture spacings (3, 5, 7, 9, and 11 mm) with 10 samples each were tested. Each sample underwent 1000 loading cycles between 5 and 20 N (combined load) at a 75-mm/min crosshead speed and subsequent load-to-failure testing. The tear opening gap between the 2 meniscal sutures was measured using the Digital Image Correlation system with 2 high-speed cameras after 10, 100, 500, and 1000 cycles. Gap formation, cyclic stiffness, and failure modes were measured. A 1-way analysis of variance with post hoc t testing with Bonferroni correction for significant pairwise analysis of all outcome variables was performed. Statistical significance was set at a P value 7 mm. Based on these biomechanical data, surgeons should consider a ≤7-mm suture interval spacing for vertical mattress meniscal repair of longitudinal tears. Clinical Relevance: On the basis of this biomechanical data, surgeons should consider a ≤7-mm suture interval spacing for vertical mattress meniscal repair of longitudinal tears.