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Barber FA, Davidson PA, Henninger HB. Biomechanical Characteristics of All-Suture Meniscal Repair Devices Compared With PEEK-Anchored Devices and Inside-Out Suture for Meniscal Repair: A Porcine Study. Orthop J Sports Med 2024; 12:23259671241245127. [PMID: 38799548 PMCID: PMC11128174 DOI: 10.1177/23259671241245127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 10/11/2023] [Indexed: 05/29/2024] Open
Abstract
Background Recently, all-suture, all-inside meniscal repair devices-including devices containing flat sutures or tapes-have been introduced. Similar to those in suture anchors, these modifications may have different performance characteristics than conventional sutures and polyether ether ketone (PEEK)-anchored devices. Purpose To compare the biomechanical characteristics of all-suture meniscal repair devices with those of a conventional PEEK-anchored device and an inside-out meniscal suture construct. Study Design Controlled laboratory study. Methods A total of 48 adult porcine menisci with simulated bucket-handle tears were included. Single-device repairs were performed with the SuperBall Meniscal Repair System, FiberStitch, and FAST-FIX 360 with 2 PEEK anchors, and a vertical mattress inside-out suture repair was performed using a Ti-Cron No. 2-0 braided polyethylene terephthalate suture. All specimens were preloaded (10 N) and cycled 200 times (between 10 and 50 N). Specimens surviving cyclic loading were then destructively tested. Endpoints included maximum failure load, stiffness, cyclic displacement, and failure mode. The goal was 12 successful tests in each group. Metrics between groups were compared using analysis of variance with post hoc tests to control for multiple comparisons. Results The SuperBall (108.9 N) was significantly stronger than the FAST-FIX 360 (67.3 N) and Ti-Cron (75.2 N), and the FiberStitch (102.8 N) was significantly stronger than the FAST-FIX 360 (P≤ .01 for all). Cyclic stiffness increased during cyclic loading for all constructs (P < .001). The Ti-Cron was significantly stiffer than the SuperBall during 5 to 200 cycles (P < .001). Cyclic displacement significantly increased in all constructs during cycling (P < .001) but did not differ between devices. Failure mode varied by device: the Ti-Cron repairs failed because of suture breakage, the SuperBall and FAST-FIX 360 failed at the anchor, and the FiberStitch showed both failure modes. Conclusion The all-suture, all-inside meniscal repair devices demonstrated superior strength to the PEEK-anchored device and the classic inside-out suture meniscal repair but no statistically significant difference in cyclic displacement.
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Affiliation(s)
- F. Alan Barber
- Plano Orthopedic and Sports Medicine Center, Plano, Texas, USA
| | | | - Heath B. Henninger
- Orthopaedic Research Laboratory, University of Utah, Salt Lake City, Utah, USA
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Wei W, Zhang Y, Li R, Ni J, Wang D, Zhang S, Shi Z. Efficacy of meniscus suture absorbability on meniscus healing success rate via second-look arthroscopy after meniscal repair: a systematic review and meta-analysis. BMC Musculoskelet Disord 2023; 24:717. [PMID: 37684657 PMCID: PMC10485939 DOI: 10.1186/s12891-023-06602-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 06/03/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND To preserve the meniscus's function, repairing the torn meniscus has become a common understanding. After which, the search for the ideal suture material is continuous. However, it is still controversial about the efficacy of suture absorbability on meniscus healing. METHODS This review is designed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. INCLUSION CRITERIA (1) Studies on meniscus repair; (2) Second-look arthroscopy was performed; (3) The meniscus was repaired by absorbable and non-absorbable sutures; (4) The healing condition of repaired meniscus via second-look arthroscopy was described. EXCLUSION CRITERIA (1) Animal studies, cadaveric studies, or in vitro research; (2) Meniscus transplantation; (3) Open meniscus repair; (4) Reviews, meta-analysis, case reports, letters, and comments; (5) non-English studies. MEDLINE, Embase, and Cochrane Database were searched up to October 2022. Risk of bias and methodology quality of included literature were assessed according to ROBINS-I and the modified Coleman Methodological Scale (MCMS). Descriptive analysis was performed, and meta-analysis was completed by RevMan5.4.1. RESULTS Four studies were included in the systematic review. Among them, three studies were brought into the meta-analysis, including 1 cohort study and 2 case series studies about 130 patients with meniscal tears combined with anterior cruciate ligament injury. Forty-two cases were repaired by absorbable sutures, and 88 were repaired by non-absorbable sutures. Using the fixed effect model, there was a statistical difference in the healing success rate between the absorbable and the non-absorbable groups [RR1.20, 95%CI (1.03, 1.40)]. CONCLUSION In early and limited studies, insufficient evidence supports that non-absorbable sutures in meniscus repair surgery could improve meniscal healing success rate under second-look arthroscopy compared with absorbable sutures. In contrast, available data suggest that absorbable sutures have an advantage in meniscal healing. TRIAL REGISTRATION The review was registered in the PROSPERO System Review International Pre-Registration System (Registration number CRD42021283739).
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Affiliation(s)
- Wang Wei
- The First Department of Orthopaedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an Jiaotong University, Xi'an, China
| | - Yi Zhang
- Department of Orthopaedics, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ruiying Li
- The First Department of Orthopaedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an Jiaotong University, Xi'an, China
| | - Jianlong Ni
- The First Department of Orthopaedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an Jiaotong University, Xi'an, China
| | - Dongjian Wang
- Second Department of Orthopaedics, Shaanxi Sengong Hospital, Xi'an, China
| | - Sanpeng Zhang
- Department of Anesthesiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an Jiaotong University, Xi'an, China
| | - Zhibin Shi
- The First Department of Orthopaedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an Jiaotong University, Xi'an, China.
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Haikal E, Mansour J, Daher M, Khoury A. Semimembranosus Tendon Entrapment by an All-Inside Meniscal Suture. Cureus 2022; 14:e29746. [PMID: 36340532 PMCID: PMC9621727 DOI: 10.7759/cureus.29746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2022] [Indexed: 11/19/2022] Open
Abstract
Meniscal suturing has become the gold standard when it comes to meniscal tears in vascularized areas, especially in the younger population. The all-inside meniscal suturing technique has gained popularity in the past year due to decreased operative time as well as decreased risk of adverse events, as compared to other modalities. However, several complications have been reported with the all-inside technique, including soft tissue and neurovascular injury. This is the first case reporting a semimembranosus tendon entrapment following an all-inside medial meniscal suture. Being aware of such complications is crucial in order to avoid them and treat them promptly should they arise.
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Atsumi S, Hara K, Arai Y, Kamitani A, Nakagawa S, Inoue H, Kubo T. Outcomes of arthroscopic repair using the all-inside inter-leaf vertical suture technique for horizontal meniscal tears sustained in sports. Medicine (Baltimore) 2020; 99:e22609. [PMID: 33031317 PMCID: PMC7544389 DOI: 10.1097/md.0000000000022609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of the study was to evaluate the outcomes of arthroscopic repair using the all-inside inter-leaf vertical suture arthroscopic technique for sports-related horizontal meniscal tears.The inter-leaf vertical suture procedure was performed to repair sports-related horizontal tears in the middle and posterior segments of the medial (11 cases) and lateral (2 cases) menisci in 13 patients (mean age: 30 ± 14 years). Pre- and post-operative Barrett criteria, Lysholm scores, and patient ability to resume sports were assessed. Magnetic resonance imaging (MRI) grades and signal intensity changes near the joint capsule were evaluated in the 9 cases among which pre- and post-operative MRI images were available.All Barrett criteria items were negative following surgery; Lysholm scores increased from 70.2 ± 13.1 before surgery to 98.9 ± 2.64 after surgery (P < .01). All patients were able to resume their sport. Preoperative MRI grade of tears was 3 for all patients; postoperative MRI grades were 1 in 3 cases, 2 in 4 cases, and 3 in 2 cases (P < .05). Importantly, MRI signal intensity at the repaired menisci near the joint capsule was reduced in 8 of these 9 cases postoperatively.The inter-leaf vertical suture procedure is associated with good outcomes for horizontal tears in the middle and posterior segments of the medial and lateral menisci. The procedure is useful and convenient.
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Affiliation(s)
- Satoru Atsumi
- Department of Orthopedics, JCHO Kyoto Kuramaguchi Medical Center
| | - Kunio Hara
- Department of Orthopedics, JCHO Kyoto Kuramaguchi Medical Center
| | - Yuji Arai
- Department of Sports and Para-Sports Medicine
| | - Aguri Kamitani
- Department of Orthopedics, JCHO Kyoto Kuramaguchi Medical Center
| | | | - Hiroaki Inoue
- Department of Orthopedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Toshikazu Kubo
- Department of Orthopedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
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Bianchi S, Fischer B, Pruès-Latour V, Wyssa B. Ultrasound Appearances of Complications After Arthroscopic Anterior Cruciate Ligament Reconstruction. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:169-179. [PMID: 31232482 DOI: 10.1002/jum.15077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 05/31/2019] [Accepted: 06/01/2019] [Indexed: 06/09/2023]
Abstract
Anterior cruciate ligament tears are among the most frequent knee injuries. Surgical treatment is mandatory in active athletes to prevent meniscal tears and early joint degenerative changes. Anterior cruciate ligament arthroscopic reconstruction (ACLAR) is considered the preferred procedure, allowing a successful functional restoration and a prompt return to sports practice. Postsurgical complications are infrequent and are mainly assessed clinically and by magnetic resonance imaging. Although ultrasound can only evaluate the outer aspect of the knee, it can detect several ACLAR complications. The aim of this pictorial essay is to present the ultrasound appearances of a wide spectrum of ACLAR complications.
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Popliteal neurovascular bundle is safe during inside-out repair of medial meniscus without a safety incision. Knee Surg Sports Traumatol Arthrosc 2019; 27:153-165. [PMID: 30019073 DOI: 10.1007/s00167-018-5060-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 07/11/2018] [Indexed: 12/28/2022]
Abstract
PURPOSE There is a theoretical risk of injury to neurovascular structures during inside-out meniscal repair without a safety incision, although there are limited studies assessing this risk. This simulation study on archival MRI films was performed to assess the risk for the popliteal neurovascular bundle and the peroneal nerve during passage of needles for inside-out meniscus repair without a "safety incision", thereby defining a "safe zone" of the menisci that can be safely repaired using this technique. METHODS Archival MRI scans (n = 50) were retrieved and axial sections through the menisci were used for simulation. The needle passage was simulated for different points on the posterior horn and body of lateral and medial menisci at "half-hour" intervals using clock method (15° intervals) with three different portals and two different needle cannulas, resulting in six different scenarios of needle passage for each point on the meniscus. The distance of the needle in each scenario was measured from popliteal vessels (n = 50) and peroneal nerve (n = 10). The value "mean-3SD" was calculated for positive means and "Mean + 3SD" was calculated if the mean was negative. An additional 2 mm was defined as "safe distance". Thus, simulation models in which the mean - 3SD was less than 2 mm (or mean + 3SD was greater than - 2 mm for negative means) were labelled as "unsafe". RESULTS Needle passage through medial meniscus at and medial to 1 o'clock position for a right knee (or 11 o'clock position for a left knee) was safe, irrespective of the portal and needle type. For the lateral meniscus, only the equatorial region was found to be safe with this method. CONCLUSIONS The popliteal neurovascular bundle is safe during the inside-out medial meniscal repair without a safety incision. For the terminal-most part of the posterior horn, the AM portal and the straight cannula should be avoided. However, this method without safety incision cannot be recommended for lateral meniscus because of the risk to the popliteal vessels and the peroneal nerve. Instead, the inside-out method with a safety incision, or an all-inside method should be used for lateral meniscus. LEVEL OF EVIDENCE III.
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Abstract
The rates of arthroscopic meniscus repair continue to increase with excellent reported outcomes. Complications, sometimes catastrophic, following meniscus repair may occur. The rate of postoperative complications may be reduced by adequate diagnosis, appropriate patient selection, meniscus repair selection, surgical techniques, and postoperative management. When complications occur, the provider must identify and take steps to rectify as well as prevent further complications from occurring. The purpose of this article is to detail the common diagnostic, technical, and postoperative pitfalls that may result in poor patient outcomes.
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Affiliation(s)
- Matthew H Blake
- Department of Orthopaedic Surgery and Sports Medicine, Avera McKennan Hospital and University Health Center, 911 East 20th Street, Suite 300, Sioux Falls, SD 57105, USA.
| | - Darren L Johnson
- Department of Orthopaedic Surgery, University of Kentucky School of Medicine, 740 South Limestone, K403, Lexington, KY 40536-0284, USA
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Atsumi S, Hara K, Arai Y, Yamada M, Mizoshiri N, Kamitani A, Kubo T. A novel arthroscopic all-inside suture technique using the Fast-Fix 360 system for repairing horizontal meniscal tears in young athletes: 3 case reports. Medicine (Baltimore) 2018; 97:e9888. [PMID: 29443758 PMCID: PMC5839842 DOI: 10.1097/md.0000000000009888] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Considering the risk of osteoarthritis following resection of a horizontally torn meniscus of the knee, repairing and preserving the meniscus as much as possible is preferred. We report 3 cases of restoration of horizontally torn menisci using a novel arthroscopic method we have called "all-inside interleaf vertical suture" that afforded preservation. PATIENT CONCERNS The 3 patients (aged 14, 17, and 21 years) had knee pain through sports activity. DIAGNOSES All patients had horizontal tears in the posteromedial part of the meniscus. INTERVENTIONS The method uses Fast-Fix, whereby a first anchor is inserted from the tibial surface of the tear's superior leaflet and a second anchor is inserted from the femoral surface of the tear's inferior leaflet, and the 2 leaflets are closed using vertical suture. In all cases, the suture knots were embedded between the superior leaflet and inferior leaflet, avoiding contact with the articular cartilage, and superior leaflet and inferior leaflet crimping was good. OUTCOMES All 3 were able to resume competing in sport and ≥ 1 year after surgery they had no pain and their postoperative mean Lysholm scores were 99.7. There were no complications or recurrence. On magnetic resonance imaging, the signal intensity of all the horizontal tears was high before surgery but low after surgery, suggesting that the repaired tear was healing. LESSONS The all-inside interleaf vertical suture procedure is a new surgical technique that can repair posteromedial horizontal meniscal tears of the knee of young people by easy crimping of the superior and inferior leaflets without the suture knots causing complications.
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Affiliation(s)
- Satoru Atsumi
- Department of Orthopedics, JCHO Kyoto Kuramaguchi Medical Center
| | - Kunio Hara
- Department of Orthopedics, JCHO Kyoto Kuramaguchi Medical Center
| | - Yuji Arai
- Department of Sports and Para-Sports Medicine
| | - Manabu Yamada
- Department of Orthopedics, JCHO Kyoto Kuramaguchi Medical Center
| | - Naoki Mizoshiri
- Department of Orthopedics, JCHO Kyoto Kuramaguchi Medical Center
| | - Aguri Kamitani
- Department of Orthopedics, JCHO Kyoto Kuramaguchi Medical Center
| | - Toshikazu Kubo
- Department of Orthopedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Warth LC, Bollier MJ, Hoffman DF, Cummins JS, Hall MM. New Complication Associated With All-Inside Meniscal Repair Device: Ultrasound-Aided Diagnosis and Operative Localization of Foreign Body Reaction. Orthop J Sports Med 2016; 4:2325967116664882. [PMID: 27635413 PMCID: PMC5011303 DOI: 10.1177/2325967116664882] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The importance of meniscal preservation has become widely accepted, and meniscal repair techniques have evolved over recent years. With new techniques come new complications, which are critical to recognize. Purpose: To describe a new complication of foreign body reaction from a nonabsorbable suture anchor associated with improper placement of the all-inside meniscal device. Study Design: Case series; Level of evidence, 4. Methods: This study was a retrospective review of 3 patients who developed pain associated with a foreign body reaction from a misplaced all-inside meniscal device. Results: All patients had a delayed diagnosis (6 months to 8 years) and negative magnetic resonance imaging (MRI). Diagnostic ultrasound identified the misplaced suture with foreign body reaction and was used to guide a diagnostic injection of local anesthetic prior to surgical intervention. Intraoperative ultrasound guidance was utilized to precisely localize and excise the suture material and associated reactive tissue. Conclusion: Foreign body reaction from a misplaced all-inside meniscal device is a previously unreported complication. Diagnosis is challenging as MRI and arthroscopy can be unrevealing. Diagnostic ultrasound was able to identify the foreign body reaction, confirm the diagnosis by facilitating diagnostic local anesthetic injection, and guide surgical excision. Sonographic evaluation should be considered in patients presenting with ongoing knee pain after all-inside meniscus repair.
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Affiliation(s)
- Lucian C Warth
- Department of Orthopedic Surgery, Indiana University Health, Fishers, Indiana, USA
| | - Matthew J Bollier
- Department of Orthopedics and Rehabilitation, University of Iowa Sports Medicine, Iowa City, Iowa, USA
| | - Douglas F Hoffman
- Department of Orthopedic Surgery, Essentia Health, Duluth, Minnesota, USA
| | - Justin S Cummins
- Department of Orthopedic Surgery, Essentia Health, Duluth, Minnesota, USA
| | - Mederic M Hall
- Department of Orthopedics and Rehabilitation, University of Iowa Sports Medicine, Iowa City, Iowa, USA.; Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
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Rapid chondrolysis of the medial knee compartment after arthroscopic meniscal resection: a case report. J Med Case Rep 2016; 10:81. [PMID: 27039072 PMCID: PMC4818872 DOI: 10.1186/s13256-016-0841-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 02/16/2016] [Indexed: 11/27/2022] Open
Abstract
Background Rapidly destructive osteoarthritis of the hip and rapid chondrolysis of the lateral compartment of the knee or the shoulder are rare, but have been previously described in the medical literature. To the best of our knowledge, no case of medial femorotibial compartment chondrolysis after arthroscopy has yet been described. We therefore submit the first case report. Case presentation A 64-year-old white European man presented with right knee pain due to a medial meniscal tear with no other abnormality found on examination or imaging. An arthroscopic partial medial meniscectomy was performed and early evolution was favorable with no signs of infection. He developed knee pain 2 months later. X-rays showed a thinning of the medial compartment which was confirmed by computed tomography arthrogram. There was no articular effusion, mobility was conserved (0/0/125°), there was no laxity, and pain was localized to the medial femorotibial compartment, with no meniscal signs. There was a 8° varus deviation (versus 3° for his uninjured left knee). His blood work was normal. As there were no signs of infection, no aspiration was performed. Viscosupplementation was offered but refused by the patient. He is now waiting for a partial knee replacement. Conclusions To the best of our knowledge, this is the first description of such a case. Rapid chondrolysis has been described in the hip, shoulder, and the lateral compartment of the knee. Infiltration of bupivacaine and lateral meniscectomy are the most frequently sited offending procedures. Concerning the medial compartment, cases of avascular necrosis have been reported after meniscectomy or use of radiofrequency devices. This case underlines the necessity of a thorough physical examination and complete radiological work up before any surgery. It must also drive us to use caution regarding meniscectomy, especially in patients over 60 years of age, and reminds us that patients must be informed of this potential complication.
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Rauck RC, Jain S, Flanigan DC. Complications Associated with FAST-FIX All-Inside Meniscal Repair: A Report of Two Cases. JBJS Case Connect 2015; 5:e62. [PMID: 29252849 DOI: 10.2106/jbjs.cc.o.00040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
CASE 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. CONCLUSION Surgeons need to be aware of this potential complication in the event that a patient presents with pain and mechanical symptoms after meniscal repair.
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Affiliation(s)
- Ryan C Rauck
- OSU Sports Medicine, The Ohio State University Wexner Medical Center, 2050 Kenny Road, Suite 3100, Columbus, OH 43221.
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Bogunovic L, Kruse LM, Haas AK, Huston LJ, Wright RW. Outcome of All-Inside Second-Generation Meniscal Repair: Minimum Five-Year Follow-up. J Bone Joint Surg Am 2014; 96:1303-1307. [PMID: 25100778 PMCID: PMC4116561 DOI: 10.2106/jbjs.m.00266] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSIONS 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. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Ljiljana Bogunovic
- Department of Orthopaedic Surgery, Washington University School of Medicine, One Barnes-Jewish Plaza, Suite 11300, West Pavilion, Campus Box 8233, St. Louis, MO 63110. E-mail address for L. Bogunovic: . E-mail address for L.M. Kruse: . E-mail address for A.K. Haas: . E-mail address for L.J. Huston: . E-mail address for R.W. Wright:
| | - Lisa M. Kruse
- Department of Orthopaedic Surgery, Washington University School of Medicine, One Barnes-Jewish Plaza, Suite 11300, West Pavilion, Campus Box 8233, St. Louis, MO 63110. E-mail address for L. Bogunovic: . E-mail address for L.M. Kruse: . E-mail address for A.K. Haas: . E-mail address for L.J. Huston: . E-mail address for R.W. Wright:
| | - Amanda K. Haas
- Department of Orthopaedic Surgery, Washington University School of Medicine, One Barnes-Jewish Plaza, Suite 11300, West Pavilion, Campus Box 8233, St. Louis, MO 63110. E-mail address for L. Bogunovic: . E-mail address for L.M. Kruse: . E-mail address for A.K. Haas: . E-mail address for L.J. Huston: . E-mail address for R.W. Wright:
| | - Laura J. Huston
- Department of Orthopaedic Surgery, Washington University School of Medicine, One Barnes-Jewish Plaza, Suite 11300, West Pavilion, Campus Box 8233, St. Louis, MO 63110. E-mail address for L. Bogunovic: . E-mail address for L.M. Kruse: . E-mail address for A.K. Haas: . E-mail address for L.J. Huston: . E-mail address for R.W. Wright:
| | - Rick W. Wright
- Department of Orthopaedic Surgery, Washington University School of Medicine, One Barnes-Jewish Plaza, Suite 11300, West Pavilion, Campus Box 8233, St. Louis, MO 63110. E-mail address for L. Bogunovic: . E-mail address for L.M. Kruse: . E-mail address for A.K. Haas: . E-mail address for L.J. Huston: . E-mail address for R.W. Wright:
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Sonnery-Cottet B, Mortati R, Gadea F, Thaunat M, Moyere F, Chouteau J. Osteolysis of the tibial plateau after meniscal repair with hybrid suture anchor. Knee Surg Sports Traumatol Arthrosc 2013; 21:2137-40. [PMID: 23138233 DOI: 10.1007/s00167-012-2296-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 10/30/2012] [Indexed: 10/27/2022]
Abstract
UNLABELLED Preservation of the meniscus and consideration for repair is important when treating meniscal tears. Many techniques for repair have been described. At present, all-inside, suture anchor-based meniscal repair systems are widely used. Arthroscopic all-inside hybrid meniscal suturing has been shown to have a low complication rate as the suture anchors remain outside the capsule leaving only the suture material inside the joint. Complications such as chondrolysis or arthrolysis have not been reported with these devices until now. The purpose of our study is to highlight the risks of osteochondral damage if these devices persist intra-articularly. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Eric D Bava
- Plano Orthopedic Sports Medicine and Spine Center, TX 75093, USA
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Wouters DB, Burgerhof JGM, de Hosson JTM, Bos RRM. Fixation of osteochondral fragments in the human knee using Meniscus Arrows. Knee Surg Sports Traumatol Arthrosc 2011; 19:183-8. [PMID: 20464370 PMCID: PMC3023860 DOI: 10.1007/s00167-010-1158-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2009] [Accepted: 04/19/2010] [Indexed: 11/24/2022]
Abstract
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.
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Affiliation(s)
- Diederick B. Wouters
- Department of General, Arthroscopic Surgery and Traumatology, TweeSteden Hospital, Dr. Deelenlaan 5, 5042 AD Tilburg, The Netherlands ,Department of Oral and Maxillofacial Surgery, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Johannes G. M. Burgerhof
- Department of Epidemiology, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Jeff. T. M. de Hosson
- Department of Applied Physics, University of Groningen, Nijenborgh 4, 9747 AG Groningen, The Netherlands
| | - Rudolf R. M. Bos
- Department of Oral and Maxillofacial Surgery, University Medical Centre Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
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Wilmes P, Lorbach O, Brogard P, Seil R. [Complications with all-inside devices used in reconstructive meniscal surgery]. DER ORTHOPADE 2009; 37:1088-9, 1091-5, 1097-8. [PMID: 18958444 DOI: 10.1007/s00132-008-1307-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
All-inside devices have become increasingly popular in reconstructive meniscal surgery since their introduction at the beginning of the 1990s. Although the latest clinical investigations show better results for conventional suture techniques, meniscal devices are an important alternative because of the low risk of neurovascular injury and the easy handling of the instruments. Over the years, many reports on specific complications related to all-inside devices have been published. Especially chondral injuries, implant loosening, device migration and capsular or neural irritations have been described. Furthermore, some authors reported on foreign body reactions and cystic granulomas after the use of meniscal fixation devices. However, there is no evidence for a higher infection rate or for specific infections after the use of intra-articular techniques. Clinical reports on complications along with biomechanical studies on meniscal repair devices have led to the enhancement of all-inside techniques through substantial modifications of established products as well as to the development of new implants. After reviewing the latest literature, the complication rate seems to be decreasing. In many ways, all-inside devices are an interesting alternative to conventional suture techniques. A precise knowledge of their potential complications and the pitfalls during surgery however is crucial to make a risk evaluation in the choice of the right technique for meniscal reconstruction.
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Affiliation(s)
- P Wilmes
- Service d'Orthopédie et de Traumatologie, Centre de l'Appareil Locomoteur, de Médecine du Sport et de Prévention, Centre Hospitalier de Luxembourg - Clinique d'Eich, Luxembourg, Luxembourg.
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Bryant D, Dill J, Litchfield R, Amendola A, Giffin R, Fowler P, Kirkley A. Effectiveness of bioabsorbable arrows compared with inside-out suturing for vertical, reparable meniscal lesions: a randomized clinical trial. Am J Sports Med 2007; 35:889-96. [PMID: 17337726 DOI: 10.1177/0363546506298582] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Techniques for repairing the meniscus include both open and arthroscopic techniques using sutures and bioabsorbable implants. The purpose of this study was to compare the effectiveness of inside-out suturing and bioabsorbable arrows for repair of vertical meniscal lesions. STUDY DESIGN Randomized controlled clinical trial; Level of evidence, 1. METHODS One hundred consecutive patients were randomly assigned to arrows (n = 51) or sutures (n = 49). Sixty-five percent of patients (31 sutures, 34 arrows) underwent a concomitant anterior cruciate ligament reconstruction. A blinded research associate conducted assessments at 6 weeks and 3, 6, 12, and 24 months postoperatively. The primary outcome was retear rate. Secondary outcomes included the Western Ontario Meniscal Evaluation Tool, Anterior Cruciate Ligament Quality of Life Outcome Measure, and side-to-side comparisons of flexion and extension. RESULTS At baseline, groups were similar in age, gender, time from injury to surgery, and length and location of tear. Mean follow-up was 28.0 +/- 8.4 months. There were 22 failed meniscal repairs (11 in each group), which did not represent a significant difference in the rate of failure between groups (P = .92). The mean quality of life scores and side-to-side differences in extension and flexion measurements were not significantly different between groups. Two patients from the arrow group crossed over into the suture group at the time of surgery because of technical difficulties with the device, and in 3 instances, a single suture was needed to keep the tear reduced while arrows were introduced. Two patients required reoperation for removal of a prominent, subcutaneous arrow, and 1 patient in the suture group suffered a transient peroneal nerve palsy during revision suturing. CONCLUSION At intermediate follow-up, there were no statistically significant differences in measured outcomes between meniscal suturing and arrows. Longer term follow-up is necessary to identify differences between these 2 treatments, particularly to estimate the incidence of articular surface damage in patients whose meniscal tear was repaired using arrows.
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Affiliation(s)
- Dianne Bryant
- School of Physical Therapy, Department of Surgery, Orthopaedic Division, University of Western Ontario, Elborn College, London, ON, N6G 1H1, Canada.
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Abstract
Preservation of the menisci is increasingly emphasized in orthopedic care of the knee. Techniques are rapidly emerging that allow easier accomplishment of this goal. In particular, the development of all-inside arthroscopic meniscal repair devices has facilitated more ready repair. A number of laboratory and clinical studies have examined these devices and comparisons with more traditional techniques have been made. Numerous reports of potential complications from these new technologies have also been described in the literature. This review covers the current options for treatment of meniscal repair, laboratory and clinical data, and also potential complications.
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Affiliation(s)
- Barton Harris
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA 22903, USA
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Hantes ME, Zachos VC, Varitimidis SE, Dailiana ZH, Karachalios T, Malizos KN. Arthroscopic meniscal repair: a comparative study between three different surgical techniques. Knee Surg Sports Traumatol Arthrosc 2006; 14:1232-7. [PMID: 16858558 DOI: 10.1007/s00167-006-0094-x] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2005] [Accepted: 11/16/2005] [Indexed: 10/24/2022]
Abstract
The purpose of this prospective study was to evaluate and compare the results of arthroscopic meniscal repair using three different techniques. Between January 2002 and March 2004, 57 patients who met the inclusion criteria underwent an arthroscopic meniscal repair. The outside-in technique was used in 17 patients (group A), the inside-out in 20 patients (group B), while the rest of the 20 patients (group C) were managed by the all-inside technique using the Mitek RapidLoc soft tissue anchor (Mitek Surgical Products, Westwood, MA, USA). Anterior cruciate ligament (ACL) reconstruction was performed in 29 patients (51%). The criteria for clinical success included absence of joint line tenderness, locking, swelling, and a negative McMurray test. The minimum follow-up was one year for all groups. The mean follow-up was 23 months for group A, 22 months for group B, and 22 months for group C. All meniscal repairs were considered healed according to our criteria in group A, while 19 out of 20 repairs (95%) healed in group B. Finally 7 of 20 repairs (35%) were considered failures in group C and this difference was statistically significant in comparison with other groups. The time required for meniscal repair averaged 38.5 min for group A, 18.1 min for group B, and 13.6 min for group C. Operation time for meniscal repair in group A was statistically longer in comparison with other groups. There were no significant differences among the three groups concerning complications. According to our results, arhtroscopic meniscal repair with the inside-out technique seems to be superior in comparison with the other methods because it offers a high rate of meniscus healing without prolonged operation time.
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Affiliation(s)
- Michael E Hantes
- Department of Orthopaedic Surgery, Medical School, University of Thessalia, University Hospital of Larissa, 20 Ipsilantou Str, 41223 Larissa, Greece.
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Heckmann TP, Barber-Westin SD, Noyes FR. Meniscal repair and transplantation: indications, techniques, rehabilitation, and clinical outcome. J Orthop Sports Phys Ther 2006; 36:795-814. [PMID: 17063840 DOI: 10.2519/jospt.2006.2177] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The purpose of this paper is to provide current knowledge regarding the indications, operative techniques, rehabilitation programs, and clinical outcomes of meniscus repair and transplantation procedures. Meniscus tears that occur in the periphery may be repaired using a variety of operative procedures with high success rates. Complex multiplanar tears that extend into the central one-third avascular zone can also be successfully repaired using a meticulous vertically divergent suture technique. The outcome of these repairs justifies preservation of meniscal tissue, especially in younger athletic individuals. Meniscal transplantation is a valid treatment option for patients who have undergone meniscectomy and have related tibiofemoral joint pain, or in whom articular cartilage deterioration in the meniscectomized compartment is present. Rehabilitation after these operations includes knee motion and quadriceps-strengthening exercises initiated the first day postoperatively. The initial goal is to prevent excessive weight bearing and joint compressive forces that could disrupt the healing meniscus repair or transplant. The protocol contains modifications according to the type of meniscal tear, if a concomitant procedure is done (such as a ligament reconstruction) or if noteworthy articular cartilage deterioration is present. Patients who have repairs of peripheral meniscus tears are generally progressed more rapidly than those who have repairs of tears extending in the central one-third region or those who undergo meniscal transplantation. The safety and effectiveness of the rehabilitation program has been demonstrated in several clinical studies. We recommend preservation of meniscal tissue, regardless of age, in active patients whenever possible.
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Affiliation(s)
- Timothy P Heckmann
- Cincinnati Sportsmedicine and Orthopaedic Center Rehabilitation, Cincinnati, OH, USA
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