All-inside Repair Research Articles

The Optimal Placement of Sutures in All-inside Repair of Meniscocapsular Separation.

Background:The aim of this study was to show the effects on the meniscus of repair applied from the femoral, the femoral-tibial and the tibial surfaces. Methods:In the treatment of meniscocapsular separation, although the accepted gold standard technique in the past was the inside-out suture technique, the current treatment method is all-inside repair methods. The all-inside techniques include the hook method and applications with a meniscus suture device. The hook method is difficult with a steep learning curve. In meniscus repair applied with the all-inside meniscus devices, the application of the suture can change the anatomic structure and position of the meniscus. Results:The suturing method applied from the tibial section of the meniscus does not disrupt the anatomic position of the meniscus in meniscocapsular separation. Thus, the optimum conditions are provided for restoration of the functions of the meniscus. Conclusion:The optimal repair in meniscocapsular separations can be considered to be that made with sutures from the tibial section of the meniscus. This technique may be helpful in obtaining better clinical results.

What Is the Optimal Minimum Penetration Depth for “All-Inside” Meniscal Repairs?

To identify desired minimum depth setting for safe, effective placement of the all-inside meniscal suture anchors. Using 16 cadaveric knees and standard arthroscopic techniques, 3-dimensional surfaces of the meniscocapsular junction and posterior capsule were digitized. Using standard anteromedial and anterolateral portals, thedistance from the meniscocapsular junction to the posterior capsule outer wall was measured for 3 locations along the posterior half of medial and lateral menisci. Multiple all-inside meniscal repairs were performed on 7 knees to determine an alternate measure of capsular thickness (X2) and compared with the digitized results. In the digitized group, the distance (X1) from the capsular junction to the posterior capsular wall was averaged in both menisci for 3 regions using anteromedial and anterolateral portals. Mean distances of 6.4 to 8.8mm were found for the lateral meniscus and 6.5 to 9.1mm for the medial meniscus. The actual penetration depth was determined in the repair group and labeled X2. It showed a similar pattern to the variation seen in X1 by region, although it exceeded predicted distances an average 1.7mm in the medial and 1.5mm in the lateral meniscus owing to visible deformation of the capsule as it pierced. Capsular thickness during arthroscopic repair measures approximately 6 to 9mm (X1), with 1.5 to 2mm additional depth needed to ensure penetration rather than bulging of the posterior capsule (X2), resulting in 8 to 10mm minimum penetration depth range. Surgeons can add desired distance away from the meniscocapsular junction (L) at device implantation, finding optimal minimal setting for penetration depth (X2+ L), which for most repairable tears may be as short as 8mm and not likely to be greater than 16mm. Minimum depth setting for optimal placement of all-inside meniscal suture anchors when performing all-inside repair of the medial or lateral meniscus reduces risk of harming adjacent structures secondary to overpenetration and underpenetration of the posterior capsule.

Results with all-inside meniscal suture in pediatrics

IntroductionIncidence of meniscal lesions is increasing in the pediatric population. Given the harmful impact of meniscectomy, meniscal repair is attempted whenever possible. The present study sought to assess the efficacy of FasT-Fix (Smith and Nephew) all-inside arthroscopic meniscal repair devices in childhood meniscal lesions. The study hypothesis was that functional results would be equivalent to those of other suture techniques. Material and methodsNineteen patients were assessed following arthroscopic meniscal repair, at a mean 6 years (range: 3–9 years). Mean age was 14.8 years. There was associated ACL tear in 31% of cases. Functional assessment used Lysholm, subjective IKDC, Tegner activity level and KOOS scores. Anatomic assessment of healing used MRI, arthroscopy or CT-arthrography. ResultsAt last follow-up, the meniscal survival rate was 89.5% (n=17/19). Functional results were good: Lysholm: 95.7/100; subjective IKDC: 90.7/100; Tegner: 7.64. Imaging found systematic healing. DiscussionAll-inside arthroscopic meniscal suture is increasingly used in adults, and can also be implemented in children or adolescents in pediatrics. FasT-Fix (Smith and Nephew) implants, although not always easy to use, ensure a perfectly functional knee and conserve long-term meniscal chondroprotection with a low risk of complications. Level of evidenceIV, retrospective study.

An All-Inside Repair for Full Radial Posterior Lateral Meniscus Tears

There is controversy about the treatment for unstable full radial posterior lateral meniscus tears, particularly that involving the posterior root. Some surgeons have advocated repairing these types of meniscus tears using various techniques, but their methods are somewhat technical. We developed the technique for an all-inside repair for full radial posterior lateral meniscus tears using the Meniscal Viper (Arthrex, Naples, FL). A doubled thread is passed through 1 edge of the radial tear by the Meniscal Viper and is kept in place without tying the knot. The Meniscal Viper is used again to set a new thread, repeating the same procedure to another edge of the tear. At this step, 2 doubled threads are passed through each stump of the tear, and both a loop end and 2 free ends of each thread are located outside of the joint. Then, 2 doubled threads pass the third thread into its own loop, pulling it out. Finally, the third thread becomes the mattress suture over the radial tear site and is fastened by sliding knot techniques. This procedure makes it easy to strictly, smoothly, and less invasively shorten the gap by drawing each stump of the meniscus in the direction of the circumference.

Biomechanical Analysis of All-Inside, Arthroscopic Suture Repair Versus Extensor Retinaculum Capsulorrhaphy for Triangular Fibrocartilage Complex Tears With Instability

To assess ulnocarpal joint stability after treatment of a peripheral triangular fibrocartilage complex (TFCC) injury with all-inside arthroscopic suture repair (SR), extensor retinaculum capsulorrhaphy with the Herbert sling (HS), and a combination of both (SR+HS). Twelve fresh-frozen, age-matched, upper-extremity specimens intact from the distal humerus were prepared. Nondestructive mechanical testing was performed to assess native ulnocarpal joint stability and load-displacement curves were recorded. A peripheral, ulnar-sided TFCC injury was created with arthroscopic assistance, and mechanical testing was performed. Each specimen was treated with SR or HS and testing was repeated. The 6 specimens treated with SR were then treated with HS (SR+HS), and testing was repeated. We used paired Student t tests for statistical analysis within cohorts. For all cohorts, there was an average increase in ulnar translation after the creation of a peripheral TFCC injury and an average decrease after repair. Herbert sling decreased translation by 21%, SR decreased translation by 12%, and SR+HS decreased translation by 26%. Suture repair plus HS and HS reduce ulnar translation the most after a peripheral TFCC injury, followed by SR alone. Ulnocarpal joint stability should be assessed clinically in patients with peripheral TFCC injury, and consideration should be made for using extensor capsulorrhaphy in isolation or as an adjunct to SR as a treatment option.

Inside-Out or Outside-In Suturing Should Not Be Considered the Standard Repair Method for Radial Tears of the Midbody of the Lateral Meniscus: A Systematic Review and Meta-Analysis of Biomechanical Studies.

The purpose was to evaluate which meniscal repair technique for radial tears of the midbody of the lateral meniscus demonstrates the best biomechanical properties. An electronic literature search was conducted using PubMed, EMBASE, CINAHL, and ScienceDirect databases. Biomechanical studies investigating the repair characteristics of radial tears in the midbody of the lateral meniscus were included. After appropriate screening, a total of 54 studies were reviewed in detail (full text), and 6 met inclusion criteria. The most common cause of exclusion was the investigation of longitudinal tears. Only two studies could be meta-analyzed. Stiffness was significantly higher for all-inside compared with inside-out repair techniques (p = 0.0009). No significant differences were observed between both suture methods for load to failure (p = 0.45). However, both studies used different all-inside devices and suture constructs. No clear conclusions can be drawn from the comparison of both types of repairs for displacement, site of failure, or contact pressure changes. Overall, there are no conclusive data to suggest that inside-out or outside-in suture repair has better load to failure or stiffness, less displacement, or different site of failure compared with all-inside repair. According to biomechanical data, it is under surgeon's preference to elect one repair technique over the other.

Repair of the Posterior Third of the Meniscus During Meniscus Allograft Transplantation: Conventional Inside-Out Repair Versus FasT-Fix All-Inside Repair

To compare conventional inside-out (IO) repair and all-inside (AI) repair for the posterior third of the meniscus during meniscus allograft transplantation (MAT). Among the 64 enrolled patients, 31 patients underwent MAT with conventional IO repair, and 33 patients underwent MAT with AI repair using the FasT-Fix instrument for the posterior third of the meniscus allograft. All of the patients were retrospectively evaluated through clinical assessment at the last follow-up (54.3 months in the IO group and 55.4 months in the AI group) and through magnetic resonance imaging assessment for meniscal extrusion at 1 year postoperatively. Thirty patients (15 in each group) were evaluated through second-look arthroscopy at 1 year postoperatively. There was no significant difference in the mean Lysholm score (91.3 in the IO group and 92.3 in the AI group; P = .358) or the mean Tegner activity scale (7.1 in each group; P = .885) between the 2 groups. There was no significant difference in the mean meniscal extrusion (2.6 mm in the IO group and 2.8 mm in the AI group; P = .454), relative percentage of extrusion value (25.6% in the IO group and 24.7% in the AI group; P = .721), or meniscal healing on second-look arthroscopy (P = .796) between the 2 groups. The difference in operative time between the 2 groups was found to be statistically significant (169.9 minutes in the IO group and 123.3 minutes in the AI group; P < .001). Our comparative study on the different techniques for posterior repair of meniscus allograft suggested that AI posterior repair using FasT-Fix could be an alternative method to conventional IO repair as it gives a similar postoperative result and requires a shorter operative time.

Biomechanical Comparison of Arthroscopic Repair Constructs for Radial Tears of the Meniscus

Background: Radial tears of the meniscus represent a challenging clinical scenario because benign neglect and partial meniscectomy have both been shown to have negative biomechanical and long-term clinical consequences. Hypothesis: Complex suture repair constructs have higher failure loads and stiffness values compared with simple constructs. Study Design: Controlled laboratory study. Methods: After radial transection of human cadaveric menisci, simulated tears were repaired arthroscopically by use of 1 of 4 repair constructs: (1) 2 inside-out horizontal sutures, (2) 2 all-inside horizontal sutures, (3) an all-inside Mason-Allen construct consisting of 4 sutures, or (4) an all-inside construct consisting of a figure-of-8 suture plus 1 horizontal suture. Meniscus specimens were harvested and tested to failure on an Instron machine. The Kruskal-Wallis test was used to evaluate for significance of maximal failure load and stiffness between groups. Results: The mean maximum failure loads were 64 ± 20 N (inside-out horizontal construct), 75 ± 16 N (all-inside horizontal construct), 86 ± 19 N (Mason-Allen construct), and 113 ± 22 N (figure-of-8 plus horizontal construct). Interconstruct comparison revealed a statistically significant difference between the figure-of-8 plus horizontal construct and all 3 remaining constructs (P < .02) as well as the Mason-Allen construct when compared with the inside-out horizontal construct (P < .01). Statistical significance was not found between the all-inside horizontal construct and the Mason-Allen construct or between the all-inside horizontal construct and the inside-out horizontal construct (P = .2 and .7, respectively). Stiffness values were lower for the inside-out construct compared with the all-inside constructs (P < .05). Conclusion: Complex all-inside repair constructs had significantly higher failure loads than a conventional, simple inside-out suture repair construct for repair of radial meniscal tears. Stiffness values among the all-inside groups were greater than those for the inside-out group. Clinical Relevance: Arthroscopic techniques are presented to produce stronger radial meniscal tear repairs.

Complications Associated with FAST-FIX All-Inside Meniscal Repair: A Report of Two Cases.

We describe the cases of two patients with a previously unreported complication associated with the all-inside FAST-FIX meniscal repair system. In both cases, anchors came loose postoperatively. Surgeons need to be aware of this potential complication in the event that a patient presents with pain and mechanical symptoms after meniscal repair.

The Effect of Knee Flexion Angle on the Neurovascular Safety of All-Inside Lateral Meniscus Repair: A Cadaveric Study

To evaluate if different knee flexion angles can modify the neurovascular injury risk during lateral meniscus repair. Twenty cadaveric knees were studied. An all-inside suture device (FasT-Fix; Smith & Nephew, Andover, MA) was placed at the posterior horn and at the medial and lateral limits of the popliteal hiatus. The minimal distances between the device and the popliteal artery and peroneal nerve were measured with the knee at 90°, 45°, and 0° of flexion through a limited posterolateral arthrotomy. The distance between the device when inserted at the lateral edge of the popliteal hiatus and the peroneal nerve decreased from a median of 26 mm (interquartile range [IQR], 3.5 mm; range, 19 to 29 mm) at 90° to 21.5 mm (IQR, 4.5 mm; range, 14 to 25 mm) at 45° and 15.5 mm (IQR, 6.5 mm; range, 4 to 20 mm) at 0° (significant differences, P < .001). The distance between the device when inserted at the medial edge of the popliteal hiatus and the peroneal nerve decreased from 16 mm (IQR, 3.3 mm; range, 9 to 21 mm) at 90° to 12 mm (IQR, 4.3 mm; range, 9 to 16 mm) at 45° and 7 mm (IQR, 4.0; range, 4 to 15 mm) at 0° (significant differences, P < .001). The distance between the device when inserted at the medial edge of the popliteal hiatus and the popliteal artery decreased from 21 mm (IQR, 5.0 mm; range, 11 to 27 mm) at 90° to 19 mm (IQR, 5.0 mm; range, 10 to 23 mm) at 45° and 16 mm (IQR, 7.5 mm; range, 10 to 23 mm) at 0° (significant differences, P < .001). The distance between the device when inserted 5 mm lateral to the posterior root of the lateral meniscus and the popliteal artery decreased from 13 mm (IQR, 4.3 mm; range, 7 to 27 mm) at 90° to 10.5 mm (IQR, 4.3 mm; range, 4 to 19 mm) at 45° and 5.5 mm (IQR, 4.0 mm; range, 0 to 14 mm) at 0° (significant differences, P < .001). The risk of injury to the popliteal artery or to the peroneal nerve during all-inside repair of the posterior half of the lateral meniscus is lower at 90° of flexion and increases with knee extension to 45° and 0°. All-inside meniscal repair of the lateral meniscus is safer with the knee at 90° of flexion.

Tibiofemoral contact pressures in radial tears of the meniscus treated with all-inside repair, inside-out repair and partial meniscectomy

BackgroundTo test contact pressures in the knee after treatment of a radial meniscus tear with an all-inside meniscal repair technique and compare the results with inside-out repair and partial meniscectomy. MethodsSix non-paired cadaveric knees were analyzed with intra-compartment pressures measured at loads of 250N, 500N and 1000N at 0°, eight degrees, 15°, and 30° of knee flexion. Compartmental contact pressures were measured for the intact medial meniscus, radial tear in the posterior horn, all-inside repair using the NovoStitch suture passer device (Ceterix Orthopaedics Inc., Menlo Park, CA), inside-out repair method, and partial meniscectomy. One-way ANOVA was used for statistical analysis. ResultsThe greatest differences in peak pressures between treatments were observed under 1000N load at 30° flexion (0.8±(SD)0.1MPa (intact meniscus), 0.8±(SD)0.1MPa (all-inside), 0.9±(SD)0.1MPa (inside-out) and 1.6±(SD)0.2MPa (partial meniscectomy)). Treatment with partial meniscectomy resulted in the highest peak pressures compared to all other states (p<0.0001 at each angle). Repair of the radial tear using the all-inside technique as well as the inside-out technique resulted in significantly decreased compartment pressures compared to partial meniscectomies (p<0.0001 at each angle). There were no significant differences between peak pressures in the intact state and after repair with the all-inside or inside-out techniques. ConclusionAn all-inside repair technique using the NovoStitch suture passer can decrease contact pressures for a radial meniscus tear similarly to the inside-out repair technique when compared to partial meniscectomy. Clinical relevanceThis novel arthroscopic suture passer warrants further analysis in the clinical setting as it may be a reliable method for repair of radial meniscal tears through an arthroscopic all-inside technique.

Location of the popliteal artery and its relationship with the vascular risk in the suture of the posterior horn of the lateral meniscus

IntroductionThe proximity of the posterior horn of the lateral meniscus to the popliteal artery determines a risk of vascular injury in its suture. The aim of this study is to determine the location of the popliteal artery, and to establish the minimal distance from the posterior wall of the lateral meniscus to the artery, the common peroneal nerve (CPN), and its correlation to other variables. Material and methodsA total of 102 magnetic resonance studies were retrospectively reviewed from patients undergoing surgery at our institution. The axial section where the lateral meniscus could be clearly defined was selected, and the measurements were performed. ResultsThe artery lay laterally to the midline in 94% of the cases. The minimal mean distance from the posterior wall of the lateral meniscus to the popliteal artery was 1.01cm (0.32–1.74, SD: 0.304). The minimal mean distance to the CPN was 1.74cm (0.75–2.87, SD: 0.374). No association was found between the minimal mean distance from the posterior wall to the popliteal artery with the height, weight, BMI, the lateral meniscus diameter, or the tibial plateau diameter. An association was found between the distance from the posterior wall to the CPN with the weight and the BMI. ConclusionsThe proximity of the posterior horn to the popliteal artery should be considered when performing sutures. This distance is within the recommended depth for all-inside meniscus repair devices. This distance is not related to height, weight, BMI, lateral meniscus nor tibial plateau diameters.

Acute and chronic menisco-capsular separation in the young athlete: diagnosis, treatment and results in thirty seven consecutive patients.

Menisco-capsular separation (MCS) is an avulsion type of injury of the medial and/or lateral meniscus and is defined as detachment of the meniscus from its capsular attachment. The aims of this study were to show the results of arthroscopic all-inside menisco-capsular repair in a large number of consecutive patients with acute or chronic MCS, emphasise the advantages of this safe treatment option and stress the superiority of the treatment on the basis of thorough physical examination of the knee joint over magnetic resonance imaging (MRI) diagnosis in MCS. We evaluated data of patients treated between October 2011 and July 2012. Inclusion and exclusion criteria were defined and demographic variables evaluated. All patients were examined physically and with MRI. Knee arthroscopy was performed and the MCS repaired through all-inside menisco-capsular repair. Postoperative treatment was standardised. Patients were followed up for at least 24 weeks. Thirty-seven athletes (12 women, 25 men) were evaluated. Only in six patients was MCS detected on MRI. In all patients, MCS was diagnosed via physical examination. Arthroscopic treatment led to significant (p < 0.01) improvement. There were no complications reported postoperatively. Isolated MCS is not as rare a meniscus pathology after trauma in young athletes as could be expected after reviewing current literature. It is occult on MRI scans in most of the cases and should therefor be taken into consideration in patients with acute or chronic tenderness at the level of the joint line and negative MRI scans. Thorough physical examination has higher diagnostic value than MRI alone, as shown in this study. Treatment of MCS using all-inside nonabsorbable sutures, as described in this study using Ultra FasT Fix®, is effective if performed by an experienced surgeon.

Evaluation of the results of arthroscopic meniscal repair

Introduction Menisci have a role in optimal knee function. Meniscal preservation in younger active individuals presenting with symptomatic meniscal disease is important. The success of meniscal repair depends on appropriate meniscal bed preparation and the surgical technique. Patients and methods A prospective study of 20 cases of post-traumatic meniscal tear was conducted during the period between March 2012 and December 2013. All cases were subjected to arthroscopic evaluation to confirm the diagnosis and ensure they fulfilled the criteria for repair on the basis of site, size, description, and associated injury of the tear. The inclusion criteria were vertical longitudinal tear from 1 to 3 cm in length in the red-red or red-white zone. The exclusion criteria were patient age older than 45 years, white-white zone tear, radial tear, and complex degenerative meniscal tear. The Lysholm score and International Knee Documentation Committee (IKDC) subjective and objective knee scores were used preoperatively and postoperatively for presentation of overall results. All cases were treated by means of the all-inside arthroscopic repair technique using a FasT-Fix meniscal repair device. Results Twenty patients were followed up for an average of 60 weeks. The mean age of the patients was 20.95 ± 1.60 years; the average suture used was 2.85; 70% had isolated meniscal injury, and 30% had associated anterior cruciate ligament (ACL) tear; the average tear length was 1.91 cm. The mean preoperative and postoperative Lysholm scores were 38.25 and 91.20, respectively. The mean preoperative and postoperative IKDC subjective evaluation results were 31.28 and 91.44, respectively. The preoperative IKDC objective evaluation results revealed 16 (80%) patients with severely abnormal knees (grade D) and four (20%) patients with abnormal knees (grade C). The postoperative IKDC objective evaluation results revealed two (10%) patients with abnormal knees (grade C), three (15%) patients with nearly normal knees (grade B), and 15 (75%) patients with normal knees (grade A). There is better improvement in scores if ACL reconstruction is performed simultaneously with meniscal repair, the procedure is performed for vertical longitudinal tears, the tear is in the 'red-red' zone, and the tear length is less than 21 mm. There were no differences in functional results on the basis of repair of medial meniscus or lateral meniscus, acute or chronic injuries, or age. Conclusion Better outcome of meniscal repair was seen in patients with vertical longitudinal tear in the red-red zone with a tear length of less than 21 mm and associated with ACL reconstruction.

Localización de la arteria poplítea y su relación con el riesgo vascular en la sutura del cuerno posterior del menisco externo

IntroductionThe proximity of the posterior horn of the lateral meniscus to the popliteal artery determines a risk of vascular injury in its suture. The aim of this study is to determine the location of the popliteal artery, and to establish the minimal distance from the posterior wall of the lateral meniscus to the artery, the common peroneal nerve (CPN), and its correlation to other variables. Material and methodsA total of 102 magnetic resonance studies were retrospectively reviewed from patients undergoing surgery at our institution. The axial section where the lateral meniscus could be clearly defined was selected, and the measurements were performed. ResultsThe artery lay laterally to the midline in 94% of the cases. The minimal mean distance from the posterior wall of the lateral meniscus to the popliteal artery was 1.01cm. (0.32-1.74, SD: 0.304). The minimal mean distance to the CPN was 1.74cm. (0.75-2.87, SD: 0.374). No association was found between the minimal mean distance from the posterior wall to the popliteal artery with the height, weight, BMI, the lateral meniscus diameter, or the tibial plateau diameter. An association was found between the distance from the posterior wall to the CPN with the weight and the BMI. ConclusionsThe proximity of the posterior horn to the popliteal artery should be considered when performing sutures. This distance is within the recommended depth for all-inside meniscus repair devices. This distance is not related to height, weight, BMI, lateral meniscus nor tibial plateau diameters.

Biomechanical Evaluation of an All-Inside Suture-Based Device for Repairing Longitudinal Meniscal Tears

A device for all-inside suture-based meniscal repairs has been introduced (NovoStitch; Ceterix, Menlo Park, CA) that passes the suture vertically through the meniscus, thereby encircling the tear, and does not require an additional incision or extra-capsular anchors. Our aim was to compare this all-inside suture-based repair with an inside-out suture repair and an all-inside anchor-based repair (FasT-Fix 360°; Smith & Nephew, Andover, MA). Longitudinal tears were created in 36 fresh-frozen porcine menisci. Repairs were performed using an all-inside suture-based meniscal repair device, an all-inside anchor-based repair, and an inside-out suture repair. They were tested with cyclic loading and load-to-failure testing. The displacement, response to cyclic loading (100, 300, and 500 cycles), and mode of failure were recorded. The stiffness of the constructs was calculated as well. The all-inside suture-based repairs and the inside-out repairs showed significantly higher loads to failure than the all-inside anchor-based repairs. The stiffness values for the 3 repairs were not different. There were no differences in initial displacement. After 100, 300, and 500 cycles, the inside-out repair had higher gap formation (displacement) than the other 2 groups. Suture failure was the predominant mode of failure across all repair techniques. The all-inside suture-based repairs and inside-out repairs did not exhibit different load-to-failure values. In addition, the all-inside suture-based repairs and the all-inside anchor-based repairs did not exhibit different displacement values during cyclic loading. When addressing a longitudinal meniscal tear, surgeons should consider biomechanical data of various repair devices and techniques in their decision-making process to maximize the mechanical strength and healing probability of the repair.

Analysis of a New All-Inside Versus Inside-Out Technique for Repairing Radial Meniscal Tears

The purpose of this study was to compare gap formation, strength, and stiffness of repaired radial tears of the meniscus treated using a new all-inside technique versus a traditional inside-out suture technique. Radial tears were created in 36 fresh-frozen porcine menisci. Repairs were performed using a novel all-inside suture-based meniscal repair device or an inside-out technique. The repairs were tested for cyclic loading and load to failure. The displacement, response to cyclic loading (100, 300, and 500 cycles), and mode of failure were recorded, and the construct's stiffness was calculated. The all-inside repairs using the novel device resulted in a significantly lower displacement (gap formation) after 100, 300, and 500 cycles (P = .002, P = .001, and P = .001, respectively). The ultimate load to failure was significantly greater for the all-inside repairs (111.61 N v 95.01 N; P = .03). The all-inside repairs showed greater stiffness (14.53 N/mm v 11.19 N/mm; P = .02). The all-inside repairs failed most often by suture breakage (suture failure). The inside-out repairs failed most commonly when the suture pulled through the tissue (tissue failure) (P < .001). For repair of radial tears of the meniscus, the vertical suture configuration created by the all-inside technique resulted in lower displacement, higher load to failure, and greater stiffness compared with the horizontal inside-out technique. In a porcine specimen meniscus repair model, the biomechanical properties of a vertical all-inside technique were superior to that of a horizontal inside-out technique. Future studies of biomechanical and clinical outcomes in human meniscal repairs with this device are warranted to explore whether this repair method is valuable to clinical practice and patient outcomes.

Outcome of All-Inside Second-Generation Meniscal Repair: Minimum Five-Year Follow-up.

Meniscal repair and preservation are the goal, when possible, of the treatment of meniscal injury. Current research on second-generation all-inside repair systems has been limited to a maximum of three years of follow-up. The purpose of this study was to evaluate the mid-term clinical success (at more than five years) of meniscal repair performed with a second-generation all-inside repair device, both as an isolated procedure and with a concomitant anterior cruciate ligament (ACL) reconstruction. This is a retrospective review of patients who underwent meniscal repair with use of the all-inside FAST-FIX Meniscal Repair System (Smith & Nephew Arthroscopy, Andover, Massachusetts) from December 1999 to January 2007. Eighty-three meniscal repairs (in eighty-one patients) were identified, and follow-up data were obtained for seventy-five (90%). Twenty-six (35%) of the meniscal repairs were performed as isolated procedures. Clinical failure was defined as repeat surgical intervention involving resection or revision repair. Clinical outcomes were also assessed with the Knee injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) score, and the Marx activity score. The minimum duration of follow-up was five years (average, seven years). Twelve patients (16%) had failure of the meniscal repair, at an average of forty-seven months (range, fifteen to ninety-five months). The data did not offer enough statistical evidence, at alpha = 0.05, to establish a difference in average patient age, patient sex, or number of sutures utilized between successful repairs and failures. There was no difference in the failure rate between isolated repairs (12%; 95% confidence interval [CI]: -0.76% to 23.76%) and those performed with concurrent ACL reconstruction (18%; 95% CI: 7.47% to 29.13%), and the average time to failure was similar between these two groups (48.1 months versus 46.6 months, p = 0.939). Postoperative KOOS and IKDC outcome scores were also similar between the groups. This report of mid-term follow-up results of primary second-generation all-inside meniscal repair demonstrates its effectiveness both as an isolated procedure and when it is performed with concurrent ACL reconstruction. After a minimum of five years of follow-up, 84% of the patients continued to demonstrate successful repair. Treatment success was further supported by favorable results on patient-based outcome measures. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Outcome of All-Inside Second Generation Meniscal Repair: Minimum 5-year Follow-up

Objectives:In the setting of injury, meniscal repair and preservation is the goal when possible. Current research on second generation all-inside repair systems is limited to a maximum of three year follow-up. The purpose of this study is to evaluate the long-term (> 5 years) clinical success of isolated meniscal repairs and those performed with concomitant ACL reconstruction using a second generation all-inside repair device.Methods:This a retrospective review of patients who underwent meniscal repair utilizing the all-inside FasT-Fix meniscal repair system (Smith & Nephew Arthroscopy, Andover, MA) between December 1999 and January 2007. Eighty-three meniscal repairs in 81 patients were identified and follow-up was obtained in 90%. Twenty-six patients (35%) had isolated meniscal repair. Clinical failure was defined as repeat surgical intervention involving resection or revision repair. Clinical outcomes (KOOS, IKDC, Marx Activity) were also assessed.Results:Minimum follow-up was 5 years (avg. 7 years). Twelve patients failed meniscal repair (16%). The average time to failure was 47 months (range, 15 - 94). There was no difference in average patient age, sex or number of sutures utilized between successful repairs and failures. There was no difference in failure rate between isolated repairs (11.5% CI: -0.76%-23.76%) and those performed with concurrent ACL reconstruction (18.3% CI: 7.47%-29.13%) and the average time to failure was similar between these two groups (48.1 months versus 46.6 months, p=0.243). Postoperative outcome scores were also similar (KOOS and IKDC).Conclusion:This first report of long term (> 5 yrs) follow-up of second generation all-inside meniscal repair demonstrates it is an effective method of primary meniscal repair for both isolated repairs and those performed with concurrent ACL reconstruction. After minimum five year follow-up, over 84% of patients continue to demonstrate successful repair. Treatment success is further supported by favorable results on patient based outcome measures.

Postoperative change in medial meniscal length in concurrent all-inside meniscus repair with anterior cruciate ligament reconstruction

Meniscus repair can restore meniscal function that transfers the axial compressive force to circumferential tensile strain. However, few reports have investigated the relationship between concurrent meniscus repair with acute anterior cruciate ligament (ACL) reconstruction and postoperative meniscal position. This study aimed to evaluate medial meniscal size and clinical results in patients who underwent ACL reconstruction and concomitant all-inside medial meniscus repair. Twenty patients underwent ACL reconstruction and concurrent medial meniscus repair of a peripheral longitudinal tear using the FasT-Fix meniscal repair device. Medial tibial plateau length (MTPL) and width (MTPW) were determined by radiographic images. We evaluated the Lysholm score, anteroposterior instability, meniscal healing and magnetic resonance imaging (MRI)-based medial meniscal length (MML) and width (MMW). Correlations between MRI-based meniscal size, radiographic measurement and height were investigated. All patients showed complete healing of the repaired meniscus in arthroscopic evaluation. However, one patient needed a subsequent meniscus repair during the follow-up period. Lysholm score and anteroposterior instability improved significantly. A better correlation was observed between MMW and MTPW than between MML and MTPL. Concurrent all-inside medial meniscus repair with ACL reconstruction significantly increased MML percentage (%MML) (100 MML/MTPL) but did not affect MMW percentage (%MMW) (100 MMW/MTPW). Concurrent all-inside medial meniscus repair with ACL reconstruction had satisfactory clinical results. %MML was increased by concurrent medial meniscus repair without affecting %MMW. Our results suggest that medial meniscus repair associated with ACL reconstruction may restore meniscal function by adjusting the anteroposterior length of the torn medial meniscus.