Abstract
PurposeMultiple techniques and implants are available for all-inside meniscal repair, but the knowledge about their failure rates and functional outcome is still incomplete. The hypothesis was that there might be differences between meniscal arrows and suture devices regarding reoperation rates and functional outcome. Thereby, the aim of this study was to compare clinical results following repair with the Biofix® arrows or the FasT-Fix® suture devices.MethodsIn this RCT, 46 patients were treated either by Biofix® (n = 21) or FasT-Fix® (n = 25). The main outcome was reoperation within 2 years. Knee function and activity level were evaluated by KOOS and Tegner activity scale.ResultsTwelve out of 46 (26 %) patients were reoperated within 2 years, nine out of 21 (43 %) in the Biofix®-group versus three out of 25 (12 %) in the FasT-Fix®-group (p = 0.018). The relative risk of reoperation was 3.6 times higher for Biofix® compared to FasT-Fix® (95 % confidence interval 1.1–11.5). Both treatment groups had significant increase in all KOOS subscales, but there were no major differences between the groups. The subgroup of reoperated patients differed from the other patients with higher Tegner score preoperatively (median 5 vs. 4) (p = 0.037) and at 3-month follow-up (median 4 vs. 3) (p = 0.010).ConclusionsThese results indicate that FasT-Fix® suture is superior to Biofix® arrows with significant lower failure rate. Functional outcome did not depend on repair technique. Higher activity score preoperatively and at 3-month follow-up in the reoperated patients indicates that activity level may influence on the risk of reoperation.Level of evidenceI.
Highlights
Meniscal repairs are likely to have better long-term outcomes than meniscal resections [17], patients report better functional outcome [11], and it is assumed that repair is superior to resection in preventing osteoarthritis, even if the healing is not complete [19]
Higher activity score preoperatively and at 3-month follow-up in the reoperated patients indicates that activity level may influence on the risk of reoperation
The relative risk of reoperation was 3.6 times higher for patients in the Biofix®-group compared to the FasT-Fix®-group (95 % confidence interval 1.1–11.5)
Summary
Meniscal repairs are likely to have better long-term outcomes than meniscal resections [17], patients report better functional outcome [11], and it is assumed that repair is superior to resection in preventing osteoarthritis, even if the healing is not complete [19]. Studying failure rates in a review of 19 studies, Grant et al found similar failure rates following inside-out techniques (17 %) compared to all-inside techniques (19 %). The follow-up time of the studies, varied from 3 months to 13 years, making the comparison of the techniques hard to interpret [9]. In a meta-analysis, comparing results following open technique, outside-in technique, inside-out technique and different all-inside techniques in 14 cohorts, Nepple et al [15] concluded with a pooled failure rate of 23 % and no differences between the techniques (failure rates, respectively, 23, 24, 22 and 24 %). A range of all-inside repair techniques and devices has been introduced. Most clinical studies on all-inside meniscal repair are retrospective, have enrolled small numbers
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