FasT-Fix System Research Articles

Outcome after Arthroscopic Meniscal Repair

Abstract Objective: The objective of this study was to evaluate the functional outcomes of all-inside meniscal repair using the Fast-Fix suturebased fixation device and its correlation with postoperative MRI findings in serving military personnel with symptomatic torn menisci. Materials and Methods: Thirty patients under 40 years of age with symptomatic meniscal tears were included in the study. Clinical evaluation, arthroscopic assessment, and meniscal repair using the Fast-Fix system were performed. Patients were followed up clinically and with postoperative MRI at one year. Functional outcomes were evaluated using the International Knee Documentation Committee (IKDC) form. Results: At one year postoperative follow-up, 10% of patients had excellent results, 66.6% had good results, 13.4% had fair results, and 10% had poor results according to the IKDC evaluation. MRI evaluation showed overall satisfactory results in 86.7% of patients. The Fast-Fix system demonstrated a success rate of 90% in this short-term follow-up study, with minimal complications. Conclusion: Arthroscopic all-inside meniscal repair using the Fast-Fix system showed promising clinical outcomes in serving military personnel with symptomatic torn menisci. The success rate was comparable to traditional suture techniques. Postoperative MRI provided valuable information for evaluating the physiological state of the repaired meniscus. Long-term followup studies are necessary to assess the structural and functional integrity of the repaired menisci over time.

An All-Inside Repair Technique for Unstable Type-IV Lateral Meniscal Posterior Root Tear

Lateral meniscal posterior root tears are defined as tears of meniscus within 9 mm from the bony root attachment. Unrepaired root tears significantly compromise the biomechanical functions of the meniscus, resulting in early and accelerated osteoarthritis. Several authors have described various techniques to reattach the posterior root of the lateral meniscus, and decent short-term results have been observed. Although most previous techniques are capable of repairing radial root tears, difficulties are encountered when repairing oblique type IV tears. In this technique note, the author describes an efficient side-to-side repair technique using the FAST-FIX system, which is practical in repairing the type IV tears of the lateral meniscus. This technique includes certain sequence of the stitches and skills of controlling the root remnant, which makes it easy to penetrate the meniscus and to achieve anatomic repair.

Medial Meniscal Ramp Lesion Repair Through Anterior Portals Using a Medial Collateral Ligament Pie-Crusting Technique

Ramp injury, that is, injury to the peripheral attachment of the posterior horn of the medial meniscus, often requires additional surgery during anterior cruciate ligament (ACL) reconstruction. Diagnosis and treatment of ramp lesions are important because unrepaired ramp lesions could cause risk to the reconstructed ACL because of anteroposterior and external rotation laxity, whereas acute rupture or chronic deficiency of the ACL could also cause ramp lesions because of instability. Ramp lesions are difficult to diagnose and treat from the anterior compartment during arthroscopy. Typically, this repair requires technically demanding skills and is performed from the posterior portal using a suture hook under visualization with the arthroscope through the intercondylar notch. Inexperienced surgeons often struggle with using the posterior portal and the suture hook. Our all-inside repair technique using the FasT-Fix system (Smith & Nephew, Andover, MA) under direct visualization from the anterior compartment accompanied by a medial collateral ligament pie-crusting technique facilitates repair of ramp lesions without causing medial instability.

Long-term outcome after all inside meniscal repair using the FasT-Fix system

PurposeMeniscal surgery is one of the most performed orthopaedic procedures. Because of its chondroprotective properties, meniscal repair should be attempted whenever possible. Several techniques are described in literature, e.g. all-inside repair using FasT-Fix System from Smith & Nephew. The aim of this study was to evaluate the outcome at a minimum of 12 years following meniscal repair using FasT-Fix System. Materials and MethodsPatients who underwent meniscal repair using FasT-Fix System in the time from 2001 to 2003 were analyzed. We included isolated meniscal tears and combined tears with a concomitant ACL rupture. A median 12-year follow-up was conducted in 2015. Failure was defined as a new surgical procedure to the same meniscus. Moreover, functional outcome was evaluated using the KOOS and tegner activity score (TAS). ResultsAt follow-up 27% had undergone further surgery to the repaired meniscus. There was no significant difference between isolated and combined group (p = 0.582). The failure rate was significantly higher in females (female 48% versus male 15%; p = 0.005). Comparing sports there was a significantly higher failure rate within soccer and indoor sports group (p = 0.002).Comparing isolated and combined injury groups there was no difference in the TAS (p > 0.05). Only 1 item of KOOS showed no significant difference: 95.33 versus 94.48 for daily life activities (p > 0.05). The other items showed significant differences.49 out of 51 patients with combined injuries suffered an additional ACL rupture. There was no significant difference regarding the meniscal repair failure rate when comparing the groups of simultaneous and delayed ACL repair (p = 0.521). ConclusionsAt 12 years’ follow-up 73% had a successful surgery. KOOS was significantly better within isolated meniscus tears. Both groups showed no difference in the TAS. There were no differences regarding failure rate in the comparison of simultaneous or delayed ACL-reconstruction.

Arthroscopic repair of the meniscal injury using meniscal repair device.

Background:Total meniscus resection after meniscus tear usually leads to faster degeneration and osteoarthritis of the knee joint. Preservation and repair of the injured menisci are therefore of great clinical importance. The aim of this study was to evaluate the clinical effects of arthroscopic repair of meniscal injuries using the Fast-Fix device.Materials and Methods:96 patients (58 males, 38 females) with mean age of 24.3 years (range 12–46 years)) with a meniscus injury were treated with the Fast-Fix device under arthroscopy between July 2007 and June 2009. The right and left knees were involved in 46 and 50 patients respectively. In 12, 46 and 38 patients, the injury was located in the anterior horn, body and posterior horn respectively. In 38, 45 and 13 patients, it was in the red, red-white, and white regions, respectively. All-inside and outside-in techniques were used for these meniscal injuries. Criteria for successful surgery were no locking pain or swelling and a negative McMurray test.Results:The mean followup period was 3.7 years (range 2–5 years). The surgical success rate was 91.7% (n = 88). The mean Lysholm score increased from 47.8 ± 10.4 preoperatively to 85.7 ± 12.8 postoperatively. The mean Tegner activity score was 7.4 ± 1.6 (range 5–9) preinjury, 2.1 ± 0.9 (range 0–4) preoperatively and 7.2 ± 2.2 (range 4–10) postoperatively (P < 0.001). A total of 92 patients (95.8%) returned to full-time work. The International Knee Documentation Committee score increased from 32.7 ± 10.7 (range 10.3–51.7) preoperatively to 82.5 ± 5.1 (range 65.1–91.2) postoperatively (P < 0.001).Conclusions:The Fast-Fix system is an efficient, safe and effective suture technique for meniscal repair.

Repair of a radial tear in the posterior horn of the lateral meniscus.

There have been no studies evaluating the clinical results after repair of a radial tear in the posterior horn of the lateral meniscus (PHLM) using the FasT-Fix system. This study was undertaken to evaluate the clinical outcomes after repair of a radial tear in the PHLM using the FasT-Fix system in conjunction with anterior cruciate ligament (ACL) reconstruction. Between September 2008 and August 2011, 15 radial tears in the PHLM identified during 132 consecutive ACL reconstructions were repaired using the FasT-Fix meniscal repair system. We classified the radial tears into three types according to the tear patterns: simple radial tear, complex radial tear, and radial tear involving the popliteal hiatus. Postoperative evaluation was performed using the Lysholm knee score and Tegner activity level. Second-look arthroscopy was performed in all cases. The mean follow-up period was 24 months. None of the patients had a history of recurrent effusion, joint line tenderness or a positive McMurray test. The meniscal repair was considered to have a 100% clinical success rate. At the final follow-up, the Lysholm knee score and Tegner activity level were significantly improved compared to the preoperative values. On the second-look arthroscopy, repair of radial tears in the PHLM in conjunction with ACL reconstruction using the FasT-Fix device resulted in complete or partial healing in 86.6% of cases. Clinical results after meniscal repair of a radial tear in the PHLM by using the FasT-Fix system were satisfactory. Case series, Level IV.

Reliability of clinical evaluation of meniscus repair with the all-inside technique

The study aimed to compare questionnaire data and clinical evaluation with an assessment of meniscal morphology conducted at arthroscopic anterior cruciate ligament (ACL) reconstruction following meniscal repair. The study involved a selected group of 17 subjects (5 women and 12 men) aged 14-33 years, who underwent meniscal repair with the Fast-Fix system followed by ACL reconstruction. The mean interval between the procedures was 9 months. Prior to each procedure, the patients were requested to fill in the Lysholm Knee Questionnaire. At review, 14 patients met the criteria of a healed meniscal repair, whereas the remaining 3 subjects presented with signs of meniscal injury. These observations were confirmed at repeat arthroscopy. The Lysholm score for the entire study group increased from a baseline value of 57.3 to 92.2 points postoperatively, with the patients with reruptured menisci also improving, from 58 to 75.3 points. 1) Our results show that clinical examination is reliable to evaluate the healing of meniscal lesions following all-inside repair, as confirmed by repeat arthroscopy. 2) A far greater increase in the Lysholm score seen in patients whose menisci were confirmed to have healed by repeat arthroscopy indicates that such questionnaires may be of help in the evaluation of treatment outcomes.

Vascular Risk Associated With Meniscal Repair Using RapidLoc Versus FasT-Fix – Comparison of Two All-Inside Meniscal Devices

Eight fresh-frozen cadaver legs (average age 72 years) were used to evaluate the risk to the popliteal artery related to the use of two all-inside meniscal repair devices, the Mitek RapidLoc (12.5 mumudegrees) and the Smith & Nephew FasT-Fix (curved). The lumen of the femoral artery was injected with barium. Anteroposterior (AP) and lateral radiographs were obtained to ensure visualization of the popliteal artery and its anatomic location. Both devices were inserted into the posterior horn of the lateral meniscus up to the hub of the needle under direct arthroscopic visualization. The distance between the needle and the artery was measured on the radiographs using calipers. The average distance from the needle to the popliteal artery was 0.5 mm (0.5 +/- 0.8 mm, range: 0-2 mm) on the lateral radiograph and 6.0 mm (6.0 +/- 6.2 mm, range: 0-19 mm) on the AP radiograph using the FasT-Fix system without the penetration limiter. None of the RapidLoc needles were within 20 mm of the popliteal artery on either of the radiographs. The FasT-Fix device came within 3 mm of the artery on both AP and lateral radiographs in 43% of the specimens. The risk to the popliteal artery was significantly greater using the FasT-Fix device compared to the RapidLoc device (P < .05). Although both instruments appear safe when used properly, the RapidLoc device seems to be safer with less risk to the popliteal artery than the current FasT-Fix meniscal repair device. When using the FasT-Fix device, the penetration limiter must be used to avoid the complications found in this study.

FastFix meniscal repair (SS-27)

From August 2001 until August 2003, 91 menisci in 76 patients were repaired using the FastFix system. ACL reconstruction was performed in 64 patients (85%). Twenty-three patients had significant chondral injuries. One to six sutures (avg. 3.12) sere used in the medial meniscus repairs. One to four sutures (avg. 1.6) were used in the lateral meniscus repairs. Fifty were red/red tears and forty-one were red/white tears. Tear patterns were classified as 71 vertical longitudinal, 12 peripheral detachments, 4 bucket handle, 1 radial, and 3 combines (1 vertical longitudinal and horizontal cleavage, 1 vertical longitudinal and flap, and 1 vertical longitudinal and radial). Patients satisfaction was very high with much less morbidity than an inside out repair. Pitfalls and problems encountered with the procedure were 1) Difficulty in proper suture positioning with the straight delivery system 2) Failure of the fixation to deploy 3) Difficulty in deploying the second fixator 4) Loss of fixation purchase during knot tightening 5) A residual loop in the knot after tightening 6) Failure to reach the rim with the fixator in large bucket handle type fragments. These problems were overcome with 1) The use of a curved inserter 2) Rotating the inserter prior to deploying the fixator 3) Modifying the fixator with a thumb stop 4) Using a smooth continuous pull for initial knot pull down followed by a knot pusher for cinching 5) And not using the device for large thick bucket handle fragments. At an average follow-up of 4.9 months (range 1 month to 4.3 years) two patients required partial meniscectomy (1 at 5 months and 1 at 6 months) for non-healing. No patient had neurovascular complications or fixators palpable under the skin.