Meniscus Repair: Update on New Techniques:

Effects of suture site or penetration depth on anchor location in all-inside meniscal repair

BACKGROUND

To evaluate the effects of suture site or penetration depth on anchor location in all-inside meniscal repair.

METHODS

Eight fresh-frozen cadaveric knees were evaluated after meniscal repair using eight FasT-Fix360 (FF360) devices (Smith & Nephew Endoscopy, Andover, MA) (16 anchors) for each knee. The penetration depth was 14mm, the distance same from the periphery to insertion point, in four knees (Group A) and that in the remaining four knees (Group B) was 18mm. The anchor location in two groups was evaluated after attentive dissection.

RESULTS

Of 32 anchors for the medial meniscus, 94% were on the capsule, including the superficial medial collateral ligament (sMCL) in both groups. For the lateral meniscus, 47% anchors in Group A and 44% anchors in Group B were on the capsule. Total three anchors were over the lateral collateral ligament (LCL), whereas 15 anchors were behind the popliteus tendon (POP). Although all three anchors settled in the subcutaneous fat were in Group B, no significant difference was observed in anchor location between two groups.

CONCLUSIONS

Secure fixation to thin membranous tissue can be achieved for the medial meniscal repair using FF360, while some were located in/on bunchy LCL or POP in lateral meniscal repair. Only anchors with additional four-millimeter penetration depth were in the subcutaneous fat, although there was no effect of the penetration depth to anchor location. Clinically, for lateral meniscal repair, penetrating toward POP/LCL should be avoided and four-millimeter deeper penetration depth might be a risk for the subcutaneous irritation.

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

PURPOSE

The purpose of the present study was to evaluate the outcome at a minimum of 7 years following meniscal repair using the RapidLoc (suture anchor) system. It was hypothesized that most patients would have an intact meniscus, as has been reported in several short- and medium-term studies.

METHODS

In the time period from 2002 to 2007, all patients with a vertical longitudinal tear of the meniscus that was judged to be repairable were treated with rasping of the tear area and nearby parameniscal synovium and fixation of the torn part with the use of RapidLoc implants. Using a surgeon-administered form, baseline information about the arthroscopic findings and procedures performed was recorded (at the time of surgery). A median 10-year (range 7-12 years) follow-up was conducted in 2014-2015, and surgical procedures to the knee following the (index) meniscal repair were registered. Treatment failure was defined as a new surgical procedure to the same meniscus.

RESULTS

At the time of follow-up, 39 out of 82 patients (48 %) had undergone further surgery to the repaired meniscus (failures). Nine of these occurred within the first 6 months after surgery, 21 within the first 12 months and 26 within the first 24 months. Thus, the failure rate was 11 % at 6 months, 23 % at 12 months and 28 % at 2 years. One-third (N = 13) of the failures occurred 2 years or later after the (index) meniscal repair.

CONCLUSIONS

Long-term results of meniscal repair using the RapidLoc implants were found to be poor with a high failure rate. In a large proportion of the cases, re-rupture appeared several years after the index surgery, and a commonly used follow-up period of 2 years would therefore fail to detect them. In the day-by-day clinical work, of interest to orthopaedic surgeons is that meniscal repair using an all-inside technique similar to the one used by the authors may not solve the problem in the long run.

LEVEL OF EVIDENCE

IV.

Meniscal repair using the inside-out technique with cross stitch

The treatment of meniscal tears continues to evolve. A few years ago most tears were treated with total meniscectomy, which evolved to partial meniscectomy and then to meniscal repair. The purpose is to preserve as much of the menisci as possible, to maintain their potential biomechanical properties, and to preserve normal knee function. Different repair techniques have been used many of them involving both vertical and horizontal sutures. We are proposing an inside-out meniscal repair technique with cross-shaped stitches that provides a 4-point fixation construct.

Biomedical devices in meniscal repair

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.