Meniscus Arrow Research Articles

Paper 32: Meniscus Repair Outcomes and Reoperation Rate in Patients Over the Age of 40

Objectives: Meniscus injuries remain a common source of morbidity in patients over the age of 40. Historically, meniscus injuries in this age group have been treated non-operatively or with surgical management limited to debridement procedures. There is strong evidence for repair over meniscectomy in younger patients, however literature remains sparce regarding repair outcomes and re-operation rates for patients over the age of 40. The objectives of this study were to document patient reported outcomes, complications, and re-operation rates for meniscus repairs in patients above the age of 40 and determine what patient demographics or injury characteristics correlated with reoperation. Methods: A retrospective chart review was conducted at a single academic institution after obtaining IRB approval. An initial query of patients over the age of 40, was performed via the CPT code 29882. Inclusion criteria consisted of patient age greater than 40 at time of initial meniscal repair. Exclusion criteria consisted of prior surgery in the ipsilateral knee, meniscal root repair, septic arthritis postoperatively, and any form of knee trauma postoperatively. Patients that met inclusion criteria were chart reviewed for relevant data including demographic information, comorbidities, surgical procedure information such as type of implant used, laterality of meniscus tear, type of tear and pattern, and revision/re-operation data. Patients were then contacted to answer full 100-point KOOS (Knee Injury and Osteoarthritis Outcome Score) questionnaires. Results: 413 total patients met inclusion criteria. The average age at time of surgery was 46 years (IQR, 43-51), and 214 patients were female (51.8%). KOOS scores were reported at a median follow-up of 24-months (IQR, 3-62). Median symptom, pain, activity of daily living (ADL), sport, and quality of life (QoL) subscales were reported as 78.6 (IQR, 60.7-92.9), 87.5 (IQR, 69.4-97.2), 94.1 (IQR, 82-100), 80.0 (IQR, 55-95), and 68.8 (IQR, 40.6-81.3), respectively. A total of 74 patients underwent reoperation (17.8%). There was no significant difference in reoperation rates when stratified by age group (40-49, 50-59, 60-69) (p=0.515). Reoperation rates were not affected by type of implant used for initial meniscus repair (Fast-fix anchor, Omnispan meniscal anchor, Meniscal cinch implant, Fiberwire, MaxBraid suture, Ethibond suture, PDS suture or Bionics meniscal arrow) (p>0.7). Average number of all-inside anchors used for repair was 2 (IQR, 2-3) and did not correlate with reoperation (p=0.49). Location of initial meniscus tear (body or posterior horn) and tear pattern did not correlate with reoperation rates (p>0.36, p>0.28 respectively). A total of 47 patients complained of postoperative stiffness, of which 28 (6.7%) underwent lysis of adhesions and/or arthroscopic debridement (p=.042). Twenty-five patients sustained a meniscal re-tear or injury, of which 17 underwent reoperation with partial or total meniscectomy. Of the total patient cohort, only seven patients ultimately went on to require ipsilateral total knee arthroplasty (1.6%). Conclusions: Patients over the age of 40 who underwent meniscus repair showed favorable reported outcomes at a mean 2-year follow-up. Reoperation rates were associated with postoperative stiffness and repeat injury. Re-operation rates in patients over 40 are comparable to reported rates of younger patients who undergo meniscus repair.

The effectiveness and safety of meniscal arrow in arthroscopic meniscal repair

Purpose: This systematic review and meta-analysis was to assess the effectiveness and safety of meniscal arrow, a commonly used all-inside techniques, in arthroscopic meniscal repair surgery. Methods: Articles from PubMed, Embase, Cochrane, Web of Science, and Clinicaltrials.gov were screened following PRISMA guidelines through May 2019. Failure rate was primary outcome of interest and complication rate were secondary outcome. Randomized controlled trials (RCTs) and observational studies (OBSs) with patients undergone arthroscopic meniscal arrow versus other techniques were included. Categorical variables were analyzed using Risk ratio (RR), via random effects models or fixed effects models. Heterogeneity was assessed using the I2 statistics and if p-heterogeneity >0.5, the sensitivity analysis was conducted to determine the strength of outcome. Results: Of the 328 articles screened, six studies (four RCTs and two cohort studies) were included. Incidence of failure was not statistically significantly different between meniscal arrow (41 event/260) and control (33 events/196) (Peto RR=1.07, 95% CI 0.53, 2.18; p-heterogeneity=0.57; 6 studies). Sensitivity analysis for this outcome corrected the high heterogeneity among studies and proved its stability. The pooled RR was statistically significantly lower in the meniscal arrow group compared with the control group for complication rate (RR: 0.42, 95% CI 0.22, 0.80; p-heterogeneity=0.18; 6 studies). Conclusions: In this meta-analysis, meniscal arrow was not significantly associated with increased risk of failure events but was associated with lower complication rate.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

All-Inside Repair of Bucket-Handle Meniscal Tears: Clinical Outcomes and Prognostic Factors

Background: There is no consensus on technique of choice for repair of bucket-handle meniscal tears (BHMTs). Purpose: To determine factors that affect patient outcomes and failure rates in patients undergoing all-inside repairs of BHMTs. Study Design: Systematic review. Methods: A systematic review of 3 databases using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed. All English-language literature from 1993 to 2019 describing clinical outcomes for patients undergoing all-inside BHMT repair with ≥12-month follow-up was reviewed by 2 independent reviewers. Patient characteristics (patient sex, age), intraoperative factors (laterality, concomitant procedures, surgical technique, implants utilized), and postoperative outcomes (failure rates) were analyzed. Study quality was evaluated with the Modified Coleman Methodology Score (MCMS). Results: Fifteen studies (1 level 1, 4 level 3, 10 level 4) with 763 total patients (64% male; average age, 26.4 years [range, 9-58 years]; average follow-up, 39.8 months [range, 12-120 months]) including 396 all-inside BHMT repairs were included. Six devices were used for repair including the Meniscal Repair System, FasT-Fix, Meniscus Arrow, Biofix Arrow, RapidLoc device, and PDS II suture, with failure rates of 13.5%, 22.4%, 27.1%, 42.9%, 45.2%, and 0%, respectively. The overall repair failure rate was 29.3% at an average of 13.0 months (range, 5.0-32.4 months), but 19.0% for devices still in use. The RapidLoc and Biofix Arrow had higher failure rates than other devices (P = .0003). Women (31%) were less likely to experience a failure than were men (69%) (P = .03). Longer follow-up duration resulted in higher failure rates (>30 months, 34.4%; <30 months, 23.4%; P = .016). In 4 studies reporting on both all-inside and inside-out repairs, no significant differences in failure rates were observed. No significant differences in failure rates were found between medial and lateral repairs nor repair with and without concurrent anterior cruciate ligament reconstruction (P > .05 for all). The overall average MCMS was 54.4 ± 12. Conclusion: The overall failure rate after all-inside repair of BHMTs is 29.3% at an average of 13.0 months, with no difference in failure rates between medial and lateral meniscal repairs. The variables shown to negatively affect the failure rates were the RapidLoc and Biofix Arrow, male sex, and longer follow-up duration.

Predictive Factors for Failure of Meniscal Repair: A Retrospective Dual-Center Analysis of 918 Consecutive Cases.

Background:Meniscal surgery is one of the most common surgical procedures performed by orthopaedic surgeons. Over the past decade, awareness has increased regarding the importance of meniscal preservation to prevent the development of osteoarthritis in the knee joint. Removal of meniscal tissue can lead to a high risk of cartilage degeneration, and moreover, meniscus-preserving surgery rather than meniscal resection is likely to have better long-term outcomes. Success rates after meniscal repair range from 60% to 95%, but many reports are based on a small number of patients.Purpose/Hypothesis:The purpose of this study was to review all meniscal repairs and potential predictors for failure during a 12-year period. We hypothesized that meniscal anchors, lateral repairs, and repairs made in conjunction with an anterior cruciate ligament reconstruction (ACLR) would have fewer failures than meniscal arrows, medial repairs, and isolated repairs. We also hypothesized that younger patients and acute tears would be associated with fewer failures.Study Design:Case-control study; Level of evidence, 3.Methods:This study was a dual-center, retrospective analysis on consecutive meniscal repairs. The surgical protocols were reviewed, including type of tear, location, associated injury to the knee, and surgery. The study endpoint was failure of repair, defined as a need for reoperation and secondary partial or total meniscal resection, within 3 years. Kaplan-Meier analysis was performed to assess repair survival, with multivariate Cox regression to adjust for confounders.Results:A total of 954 meniscal repairs were performed on 918 patients (536 male patients [58%]; 382 female patients [42%]) with a mean age of 26 years (range, 12-60 years). The failure rate for the entire cohort was 22.5%. Bioabsorbable arrows had significantly more failures than all-inside sutures with anchors (hazard ratio [HR], 1.8; 95% CI, 1.2-2.5; P = .002). Medial meniscal repairs had a higher failure rate than lateral meniscal repairs (HR, 3.7; 95% CI, 2.3-6.0; P < .001). Simultaneous ACLR resulted in less failure than when no simultaneous ACLR was performed (HR, 0.5; 95% CI, 0.3-0.9; P = .009). Age at repair and acuity of tear did not affect the outcome (P = .6 and .07, respectively).Conclusion:The failure rate after meniscal repair was significantly higher on the medial side, especially when using arrows. Meniscal repairs performed concomitantly with an ACLR result in fewer reoperations.

Inside-Out Versus All-Inside Repair of Isolated Meniscal Tears: An Updated Systematic Review

Background: Meniscal tears are common in the young, active population. In this group of patients, repair is advised when possible. While inside-out repair remains the standard technique, recent advances in all-inside repair devices have led to a growth in their popularity. Previous reviews on the topic have focused on outdated implants of limited clinical relevance. Purpose: To determine the difference in failure rates, functional outcomes, and complications between inside-out and modern all-inside repairs. Study Design: Systematic review. Methods: A systematic review was registered with PROSPERO and performed following Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines using the MEDLINE, EMBASE, and Cochrane databases. Inclusion criteria were (1) clinical study reporting on all-inside or inside-out repair, (2) evidence levels 1 to 4, and (3) use of modern all-inside implants for all-inside repairs. Exclusion criteria were (1) use of meniscal arrows or screws and (2) concomitant surgical procedures. Study characteristics, subjects, surgical technique, clinical outcomes, and complications were collected and analyzed. Results: A total of 481 studies were screened and assessed for eligibility, which identified 27 studies for review. Studies defined clinical failure as persistent mechanical symptoms, effusion, or joint line tenderness, while anatomic failure was incomplete or no healing on MRI or second-look arthroscopy. There were no significant differences in clinical or anatomic failure rates between inside-out and all-inside repairs (clinical failure: 11% vs 10%, respectively, P = .58; anatomic failure: 13% vs 16%, respectively, P = .63). Mean ± SD Lysholm and Tegner scores for inside-out repair were 88.0 ± 3.5 and 5.3 ± 1.2, while the respective scores for all-inside repair were 90.4 ± 3.7 and 6.3 ± 1.3. Complications occurred at a rate of 5.1% for inside-out repairs and 4.6% for all-inside repairs. Conclusion: The quality of the evidence comparing inside-out and all-inside meniscal repair remains low, with a majority of the literature being evidence level 4 studies. In this review comparing modern all-inside devices with inside-out repair, no differences were seen in failure rates, functional outcome scores, or complication rates.

Traumatic isolated osteochondral fractures of medial femoral condyle treated with multiple retrograde Kirschner wires – A simple cost-effective technique

Management of osteochondral fractures of the knee is very crucial to prevent early onset osteoarthritis in young adults. Currently, fixation by biodegradable screws, bioresorbable pins or meniscus arrows can be expensive and also carries risk of complications, such as synovitis and osteonecrosis. In a developing country such as India, there is a need of cost-effective, safe and reproducible treatment option to fix these kinds of fractures. We report the results in 11 patients (seven males and four females) with mean age of 28.09 years, with isolated traumatic osteochondral fracture of medial femoral condyle that was treated between June 2011 and May 2015 with multiple Kirschner wires (K wires). Mean time interval between injury and surgery was 4 days (range, 2–6 days). Through medial parapatellar arthrotomy, the fragment was fixed to its corresponding bed in the medial femoral condyle in a retrograde manner with multiple non-parallel K wires (1.6–2.5mm). K wires were first drilled through the reduced fragment, the medial femoral condyle and out through the skin on medial side of knee and distal thigh while ensuring through the arthrotomy site that the intra-articular tips of the wires were flush or just buried below the cartilaginous surface of the fragment. Mean time of the union was 8.5 weeks and full range of motion was achieved by 11 weeks. Mean follow-up was 54 weeks (range, 40–64 weeks). Clinical outcomes were found to be excellent in all the patients. Mean IKDC score was 94.9, mean Lysholm score was 94.8 and mean Likert score was 4.63 (range, 4–5) indicating a high level of satisfaction. None of the patients developed any major complications. In third world countries with limited resources, multiple K wires are a safe, reproducible and relatively inexpensive method of treating these complex joint injuries in young adults.

All-inside suture device is superior to meniscal arrows in meniscal repair: a prospective randomized multicenter clinical trial with 2-year follow-up.

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.

The Meniscus Arrow® as a fixation device for the treatment of mallet fractures: results of 50 cases.

The treatment of mallet fractures is a controversial and challenging problem. Generally, mallet fractures are treated conservatively except those involving more than one third of the base of the distal phalanx. Many different surgical fixation techniques have been published. This paper describes a new fixation procedure using ultimate bioresorbable meniscal fixation nails (Meniscus Arrows®). Mallet fractures in 50 digits of 49 patients were fixed with this nail in an outpatient surgical procedure, mostly under local (Oberst-block) anaesthesia. The average operation time was 21min. According to the Crawford criteria, patient outcome was graded as excellent in 48%, good in 22%, and fair in 28%. In one patient, the outcome was graded as poor, but the fracture was in a pre-existent arthritic joint. All fractures were consolidated without recurrent dislocation. Complications included one wound infection, which was successfully treated with antibiotics and without further consequences. No nail deformities occurred. Two times, the nail spontaneously and gradually dislocated during intensive use of the hand after, respectively, 3 and 6months and could easily be removed under local anaesthesia without any functional sequelae. The bioresorbable meniscal nail fixation technique provides a fast and successful surgical treatment for mallet fractures with a minimum of adverse events.

Tibial eminence fractures in the paediatric population: A systematic review

IntroductionWe present a systematic review of the literature for the management of tibial eminence fractures in the paediatric population. Our aims were to assess modalities of injury, treatment options available and their associated complications.Materials and methodsWe found 740 relevant citations in the English literature up to 1 October 2012, of which 36 full text articles met our inclusion criteria.ResultsOur results show that skiing, sports and motor vehicle accidents are increasingly common modes of injury, in addition to the commonly described fall off of a bicycle. Most studies advocate non-operative management for type I Meyer’s and McKeever’s fractures and reduction and internal fixation for type II and III fractures. Better long-term results have been reported with arthroscopic surgery compared to open surgery. There is no consensus as to which type of fixation is best suited for tibial eminence fractures; methods available include excision of the bony fragment, K-wire, screw and, absorbable suture fixation, and more recently, suture anchor and meniscal arrow. The main complications reported include arthrofibrosis, non-union, mal-union, pain and severe laxity. Early post-operative range of motion exercises have been shown to reduce the incidence of arthrofibrosis.ConclusionAs all papers report results from small case series, Level I studies are required to produce more definitive evidence for the management of paediatric tibial eminence fractures.

Successful fixation of Mason type 2 radial head fractures using Meniscus Arrows

Previous experience has revealed excellent outcomes when using the Meniscus Arrow (Conmed Linvatec Ltd., Tampere, Finland) bioabsorable meniscal repair system for the fixation of small fracture fragments. This study describes the results of the fixation of Mason type 2 radial head fractures with these Arrows in a prospective series of 21 patients. Between 2006 and 2010, a total of 21 patients were treated with Meniscus Arrows for the fixation of Mason type 2 fractures of the radial head during an open procedure. Twenty-one, twenty and seventeen patients were followed up at 2 and 6 post-operative weeks, 18 weeks and 24 months, respectively. Radiographs were obtained during follow-up visits, and range of motion was classified according to the Weseley classification. At 24 post-operative months, 88 % of patients showed 'excellent' and 12 % showed 'good' results in terms of extension. All patients (100 %) showed 'excellent' results for flexion, supination and pronation. Uneventful healing of the fracture was observed in all patients. No complications were noted. This study shows promising outcomes for the use of Meniscus Arrows as fixation devices in the treatment for Mason type 2 fractures of the radial head.

Paper 97: Outcomes After Meniscal Repair Using the Meniscal Arrow in Knees Undergoing Concurrent Anterior Cruciate Ligament Reconstruction: Analysis of Durability of Repair

Paper 97: Outcomes After Meniscal Repair Using the Meniscal Arrow in Knees Undergoing Concurrent Anterior Cruciate Ligament Reconstruction: Analysis of Durability of Repair

Influence of test temperature on biomechanical properties of all-inside meniscal repair devices and inside-out meniscus sutures—Evaluation of an isolated distraction loading, worst-case scenario

Background Studies on the biomechanical properties of meniscus repairs are usually performed at room instead of body temperature. However, various all-inside meniscal repair devices include bioabsorbable materials, which are mechanically sensitive to higher environmental temperatures. Therefore, we hypothesize that current test standards may systematically lead to a false overestimation of their performance. Methods In 84 cadaveric bovine lateral menisci, an artificial vertical lesion was repaired with different all-inside meniscal repair devices (FasT-Fix, FasT-Fix AB, RapidLoc, Meniscus Arrow, Meniscus Screw) compared to a vertical inside-out Ethibond Excel 2.0 suture loop. Maximum load-to-failure, stiffness, and failure mode were tested in a uniaxial distraction loading at 20 °C and 37 °C. Findings Most of the tested implants were not susceptible to the higher environmental test temperature with respect to maximum load-to-failure, stiffness, and failure mode. Only the RapidLoc showed a significantly decreased stiffness (- 28.1%) and a statistical trend to lower maximum load-to-failure (- 20.6%) at 37 °C compared to 20 °C. Interpretation 20 °C environmental temperature seems to be an acceptable test condition for the most meniscal repair devices. However, if the bioabsorbable part of the implant is the weakest link, body temperature may be considered for testing to prevent false overestimation of the biomechanical properties. For future biomechanical in vitro testing of meniscal repair devices, this study may provide novel insight into biomechanical test protocols for considering the environmental test temperature as an influencing factor of the biomechanical properties of especially bioabsorbable meniscal repair devices.

The arthroscopic treatment of displaced tibial spine fractures in children and adolescents using Meniscus Arrows®

PurposeThis article summarises the results of a newly developed technique that utilises Meniscus Arrows® for the arthroscopic fixation of displaced tibial spine fractures in children and adolescents.MethodTwelve tibial spine fractures in the knees of eleven children between 6 and 15 years old, with an average age of 12 years, were arthroscopically fixed with Meniscus Arrows®, after a reduction of their fractures. This was followed by 5 weeks immobilisation in a plaster of Paris. Postoperative follow-up included radiographs, Lachmann tests on all of the children’s knees and KT-1000 tests of eight out of twelve of the children’s knees. The postoperative follow-up time ranged from 3 to 10 years, with patients being seen for an average of 4 years.ResultsAll of the fractures consolidated uneventfully, and all of the patients returned unrestricted to their previous activity level. The Lachmann tests revealed no, or a non-functional, laxity in any of the patients’ knees. The KT-1000 tests showed a difference between the operated side, and non-operated side, of between 3 mm in the first knee operated on and an average of 1 mm in the remaining knees.ConclusionThe arthroscopic fixation of tibial spine fractures using Meniscus Arrows® showed that this minimally invasive procedure resulted in the uneventful consolidation of all twelve of the fractures, with excellent results, and without the need for a second, hardware removal, operation. Level of Evidence: Level IV

Tensile and Shear Loading Stability of All-Inside Meniscal Repairs

Background: Most biomechanical studies for evaluation of the structural properties of meniscal repairs have been performed in tensile loading scenarios perpendicular to the circumferential meniscal fibers. However, meniscal repair constructs are also exposed to shear forces parallel to the circumferential meniscal fibers during healing, particularly in the midportion of the meniscus. Hypothesis: Material properties of meniscal repair devices cannot be extrapolated from tensile to shear load scenarios. Study Design: Controlled laboratory study. Methods: In 84 harvested and isolated bovine lateral menisci following removal of adjacent soft tissue, a standardized vertical lesion was set followed by repair using all-inside flexible (FasT-Fix, FasT-Fix AB, RapidLoc) and rigid (Meniscus Screw, Meniscus Arrow) meniscal repair devices. Vertical and horizontal 2.0 Ethibond sutures were used as controls. The repaired meniscal construct was tested in a tensile (parallel to the axis of the tested repair device) and shear load scenario (perpendicular to the axis of the tested repair device) at 5 mm/min and 37°C environmental temperature. Maximum load to failure, stiffness, and failure mode were recorded. Results: The absolute load to failure values of each repair device in the shear scenario were only marginally different from the tensile load scenario. However, the stiffness of several tested devices was markedly reduced in the shear scenario. In both scenarios, large differences of the load to failure and the stiffness between the implant types up to 5-fold were found (P < .05). The failure mode of several all-inside flexible repair devices was different in the shear versus tensile load scenario, while the failure mode of the rigid systems was similar in both scenarios. Conclusion: All-inside meniscal repair devices exposed to shear load scenarios have comparable maximum loads to failures as tensile load scenarios. However, the stiffness of the majority of the flexible meniscal repair implants in a shear load scenario is markedly reduced. The applied scenario also affects the failure mode in several flexible meniscal repair devices. Clinical Relevance: Meniscal repair devices with sufficient stiffness and stability against shear loads may be favored for meniscal repair, especially within the midportion of the meniscus where shear loads occur during healing.

All-Inside Meniscal Repair with Bioabsorbable Meniscal Screws or with Bioabsorbable Meniscus Arrows

Background All-inside meniscal repairs have gained popularity in the past few years. However, only a few prospective, randomized clinical studies have been done to compare different all-inside meniscal repair techniques. Hypothesis Meniscal repair with bioabsorbable meniscal screws and arrows results in similar clinical outcome on short-term follow-up. Study Design Randomized controlled trial; Level of evidence, 2. Methods Forty-two patients were prospectively randomized to have all-inside meniscal repair either by using bioabsorbable meniscal screws or bioabsorbable meniscus arrows (21 patients, 23 meniscal repairs in each group) for the fixation. The evaluation methods were clinical examination, Lysholm score, the International Knee Documentation Committee (IKDC) knee score, and magnetic resonance arthrography (MRA) evaluation. The average follow-up time was 27 months (standard deviation, 8). Results There were no differences between the study groups preoperatively. All 42 patients (100%) were available for the follow-up. However, during the follow-up, 11 patients had clinical failure, confirmed at second-look arthroscopy, of the repair leading to partial meniscal resection. Four failures (all on the medial meniscus) were observed with the use of meniscal screw fixation (17%), and 7 (4 on the medial meniscus, and 3 on the lateral meniscus) with the use of meniscus arrow fixation (30%) (P = .242). Six patients with meniscus arrows (29%) had chondral damage on the femoral condyles evaluated by MRA or at second-look arthroscopy, while none of the patients with the meniscal screws had the same (P = .018). However, the Lysholm and the IKDC scores were similar in both groups at follow-up. Conclusion All-inside meniscal repair with bioabsorbable meniscal screws and arrows resulted in similar clinical outcome, although significantly more chondral damage was observed when using bioabsorbable meniscus arrows for fixation.

Fixation of osteochondral fragments in the human knee using Meniscus Arrows®

The aim of this study is to compare the hold in bone of Meniscus Arrows® and Smart Nails®, followed by the report of the results of the clinical application of Meniscus Arrows® as fixation devices. First, pull-out tests were performed to analyse the holdfast of both nails in bone. Statistical analysis showed no significant difference; therefore, the thinner Meniscus Arrow® was chosen as fixation device in the patient series of two patients with a symptomatic Osteochondritis dissecans fragment and three patients with an osteochondral fracture of a femur condyle. The cartilage margins were glued with Tissuecoll®. All fragments consolidated. Second look arthroscopy in three patients showed fixed fragments with stable, congruent cartilage edges. At an average follow-up period of 5 years no pain, effusion, locking, restricted range of motion or signs of osteoarthritis were reported. Based on the results of the pull-out tests and available clinical studies, Meniscus Arrows® and Smart Nails® are both likely to perform adequately as fixation devices in the treatment of Osteochondritis dissecans and osteochondral fractures in the knee. They both provide the advantage of one stage surgery. However, based on their smaller diameter, the Meniscus Arrows® should be preferred for this indication.

Ergebnisse der Meniskusrefixation mit Pfeilen

In the period between August 2000 and January 2009 articles were retrieved from the American “National Library of Medicine” in the framework of a systematic search for the key words “meniscal repair” and “meniscus arrow”. The authors’ opinions on the use of meniscus arrows were categorised as “positive”, “differentiated” and “unsatisfactory”. In all, 15 publications were found that reported clinical results of meniscal repair using arrows. Six studies were published between 2002 and 2004 which considered arrows and sutures to be equivalent. Of the nine studies published between 2005 and 2009 five studies fell into the category “unsatisfactory”, three studies into “differentiated” and one study into “positive”. The clinical success rate of 90% (87–97%) found in the studies published between 2002 and 2004 decreased to 74% (59–95%) as published between 2005 and 2009. The average follow-up in the studies published between 2002 and 2004 was 34 months compared to 47 months in the studies published between 2005 and 2009. The results of this literature review indicate that, if meniscal parts are accessible for suture, the conventional outside-in or inside-out suture techniques should be applied instead of arrows.

MRI signal changes in completely healed meniscus confirmed by second-look arthroscopy after meniscal repair with bioabsorbable arrows

This study evaluated the MRI signal characteristics and MRI diagnostic accuracy in identifying completely healed menisci repaired with bioabsorbable arrows. A total of 34 patients (38 menisci), with a mean age of 26.0 years, underwent arthroscopic meniscal repair with bioabsorbable arrows and concomitant anterior cruciate ligament (ACL) reconstruction. Of the 34 patients, 27 were male and 7 were female. Of the 38 menisci, 27 were medial and 11 were lateral. Second-look arthroscopy was performed for each patient while taking out the hardware for ACL reconstruction of the tibial side to evaluate the healing status of the repaired menisci. Postoperative MRI was done 2 days before or after second-look arthroscopy. Sagittal T1, T2 and PD images and coronal T2 and PD images were used as the main diagnostic serials. Second-look arthroscopy showed that surfaces of the repaired sites of all 38 menici were almost smooth. In all 38 cases the tail ends of meniscus arrows disappeared and in four patients new overlying injury of compartmental cartilage at the repaired side was detected. MRI results revealed that different serials had different diagnostic accuracy. Sagittal: T1 28.9%, PD 34.2%, T2 60.5%. Coronal: PD 36.8%, T2 65.8%. The double sides Grade 3 signal had a higher proportion in saggital T1 and PD serials, 47.4 and 39.5%, respectively, while lower in sagittal and coronal T2 serials, both 5.3%. MRI diagnostic accuracy was correlated positively with the follow-up time (P < 0.05). MRI has its limitation in evaluating the status of menisci repaired with bioabsorbable arrows, especially for PD and T1 serials. T2 serials have higher diagnostic accuracy than other serials. MRI diagnostic accuracy can be improved by prolonging follow-up time and might be improved by further classifying Grade 3 signal in terms of signal intensity and the shape of the signal margin.

Is the Use of Biodegradable Devices in the Operative Treatment of Avulsion Fractures of Fingers, the So-Called Mallet Finger Advantageous? A Feasibility Study with Meniscus Arrows®

Purpose:Treatment of Mallet fingers or fractures remains a controversial topic. No evident preference can be distilled from the reports of the clinical results obtained by conservative treatment with splints and internal fixation. If operative treatment is indicated, several techniques can be used. However, each technique has disadvantages like the risk of comminution of the fragment, the risk of infection and necrosis, a demanding operative technique and-or the necessity of removing the metallic devices. This can be avoided by the use of biodegradable devices. The purpose of this feasibility study was to evaluate the outcome of internal fixation of a Mallet fracture with a biodegradable device, the Meniscus Arrow®.Methods:We treated nine consecutive patients with a Mallet fracture by fixation of the fragment with a biodegradable Meniscus Arrow®, at this moment the smallest device available, with an average operation time of 14 minutes.Results:Postoperatively, no complications were found. All patients were satisfied by the results after surgery, with a restored range of motion in the distal interphalangeal joint as previously and good alignment with full consolidation of all fractures at radiological evaluation.Conclusions:The operative treatment of bony mallet fingers with the Meniscus Arrow® is a fast procedure without complications in our prospective series of nine patients and without the need of a second operation to remove the implant.

Parameniscal cyst formation after arthroscopic meniscal repair with biodegradable meniscal arrow: a case report

A 22-year-old male underwent an arthroscopic meniscal repair, using meniscal arrows, due to bucket-handle medial meniscus tear. Magnetic resonance images (MRI) at 3 years revealed a large parameniscal cyst protruding into the extra-capsular popliteal space. Arthroscopic partial cystectomy, removing only the intra-articular portion of the cyst was performed, leaving the extra-articular part of the cyst. Sixteen months postoperatively MRI revealed no cyst remnants, and the patient was free of symptoms.