Unsatisfactory Clinical Results of Meniscal Repair Using the Meniscus Arrow

Abstract

The all-inside technique using the Meniscus Arrow (Bionx Implants, Malvern, PA) has become a popular method for repairing meniscal tears. The few published clinical studies have been promising. The present study, with longer follow-up and larger numbers, does not show encouraging results. The clinical efficacy, failure rate, and associated complications of meniscal repair using the Meniscus Arrow with a minimum follow-up of 3 years are described. Consecutive case series. We studied 60 consecutive meniscal repairs in 57 patients (average age, 27 years) using exclusively the Meniscus Arrow. Follow-up averaged 54 months (range, 36 to 70 months). The anterior cruciate ligament (ACL) was intact in 12 knees (12 repairs), whereas 42 patients (45 repairs) underwent concomitant ACL reconstruction. One patient (2 repairs) had radiofrequency shrinkage of the ACL and another patient (1 repair) underwent concomitant arthroscopic fixation of a tibial eminence fracture. Seventeen of 60 repairs (28%) were documented as failures by repeat arthroscopy or magnetic resonance imaging; 5 of 12 repairs (42%) performed in knees with an intact ACL failed; and 9 of 45 menisci (20%) repaired in conjunction with an ACL reconstruction also failed. The remaining 3 failures occurred in knees with unsuccessful ACL procedures. The type of meniscus tear and the postoperative rehabilitation regimen were also factors that influenced the success rate in this study. Fifteen patients (26%) underwent a second operation because of persistent postoperative symptoms. One patient, whose repair failed, deferred a repeat operation after sustaining a postoperative pulmonary embolism. Contrary to previously published studies that reported good clinical results, this series revealed a 28% failure rate with significant postoperative complications, such as chondral scoring, fixator breakage, and postoperative joint-line irritation. This study has raised concerns about the continued liberal use of the Bionx Meniscus Arrow, leading the authors to abandon its use for repairing meniscal tears. Level IV.