Meniscal repair using the Polysorb Meniscal Stapler XLS

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

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.

Comparison of inside-out and all-inside techniques for the repair of isolated meniscal tears: a systematic review

BACKGROUND

Arthroscopic meniscal repair techniques are continuing to evolve. Most studies to date comparing the healing rate of inside-out to all-inside meniscal repair techniques are confounded by associated anterior cruciate ligament reconstruction or deficiency.

PURPOSE

This review was conducted to compare the effectiveness and complications of the inside-out repair technique to that of the all-inside repair technique in isolated unstable peripheral longitudinal ("bucket-handle") meniscal tears.

STUDY DESIGN

Systematic review.

METHODS

Computerized keyword searches of MEDLINE, EMBASE, CINAHL, ACP Journal Club, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews were performed. Two reviewers independently performed searches and article reduction. Studies that included stratified data for isolated unstable longitudinal meniscal tears in stable knees, repaired with either an inside-out or all-inside repair technique, were selected. Data on clinical failure, subjective outcome measures, and complications were summarized.

RESULTS

Nineteen studies included data specific to isolated meniscal tears. The rate of clinical failure was 17% for inside-out repairs and 19% for all-inside repairs. Lysholm scores and Tegner activity scores were similar between the 2 repair methods (87.8 vs 90.2 and 5.6 vs 5.5, respectively). The prevalence of nerve injury/irritation was higher with the inside-out technique (9% vs 2%). All-inside techniques had a higher rate of local soft tissue irritation, swelling, and implant migration or breakage. The use of older generation, rigid, all-inside implants is associated with chondral injury.

CONCLUSION

There are no differences in clinical failure rate or subjective outcome between inside-out and all-inside meniscus repair techniques. Complications are associated with both techniques. More nerve symptoms are associated with the inside-out repair and more implant-related complications are associated with the all-inside technique.

CLINICAL RELEVANCE

Rates of structural healing and complications are comparable for inside-out and all-inside repair techniques for isolated meniscal injury. Differences in observed healing rates after meniscal repair may be more dependent on tear pattern and associated anterior cruciate ligament reconstruction rather than an inside-out versus all-inside surgical approach.

Meniscal repair versus partial meniscectomy: a systematic review comparing reoperation rates and clinical outcomes

PURPOSE

The aim of this investigation was to compare reoperation rates and clinical outcomes after meniscal repair and partial meniscectomy.

METHODS

A systematic literature review was performed to identify outcome studies of arthroscopic meniscal repair (inside-out, outside-in, and all-inside techniques) or partial meniscectomy in patients with traumatic meniscal tears. The studies included patients with no previous injuries or operations.

RESULTS

At short- and long-term follow-up, partial meniscectomy had a lower reoperation rate (1.4% [2 of 143] and 3.9% [52 of 1,319], respectively) than isolated meniscal repair (16.5% [47 of 284] and 20.7% [30 of 145], respectively). There was a slightly higher reoperation rate after partial lateral meniscectomy compared with partial medial meniscectomy. Repairs of the medial meniscus resulted in higher reoperation rates than repairs of the lateral meniscus. Meniscal repairs at the time of anterior cruciate ligament reconstruction had a lower failure rate than isolated repairs. In the limited number of studies with long-term clinical outcome scores, meniscal repair was associated with higher Lysholm scores and less radiologic degeneration than partial meniscectomy.

CONCLUSIONS

Whereas meniscal repairs have a higher reoperation rate than partial meniscectomies, they are associated with better long-term outcomes.

LEVEL OF EVIDENCE

Level IV, systematic review of Level I-IV studies.

Meniscal tear biomechanics: loads across meniscal tears in human cadaveric knees

This study examined the forces during motion across human meniscal tears. Longitudinal cuts were created in 6 human cadaveric knees at the red-white junction of the medial and lateral menisci into which a pressure transducer was placed. Pressure data were gathered with the knees at neutral, internal rotation, and external rotation and matched to knee flexion. The meniscal cuts were compressed throughout the range of motion. No distraction pressures were observed. Therefore, meniscal tear displacement does not occur with knee motion and a meniscal repair device load-to-failure strength may be less important than the device's ability to accurately reduce a meniscal tear and avoid shear stress.