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Oosten JD, DiBartola AC, Wright JC, Cavendish PA, Milliron EM, Magnussen RA, Duerr RA, Kaeding CC, Flanigan DC. More Is Not Merrier: Increasing Numbers of All-Inside Implants Do Not Correlate with Higher Odds of Revision Surgery. J Knee Surg 2024; 37:361-367. [PMID: 37336501 DOI: 10.1055/a-2112-8158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
The purpose of this study was to evaluate the relationship between the number of all-inside meniscal repair implants placed and the risk of repair failure. We hypothesized that the use of higher numbers of all-inside meniscus repair implants would be associated with increased failure risk. A retrospective chart review identified 351 patients who underwent all-inside meniscus repair between 2006 and 2013 by a sports medicine fellowship-trained orthopaedic surgeon at a single institution. Patient demographics (age, body mass index [BMI], sex) and surgical data (number of implants used, concomitant anterior cruciate ligament reconstruction [cACLR], and tear type/size/location) were recorded. Patients who received repairs in both menisci or who had follow-up < 1-year postoperatively were excluded. Repair failure was identified through chart review or patient interviews defined as a revision surgery on the index knee such as partial meniscectomy, total knee arthroplasty, meniscus transplant, or repeat repair. Logistic regression modeling was utilized to evaluate the relationship between the number of implants used and repair failure. A total of 227 all-inside meniscus repairs were included with a mean follow-up of 5.0 ± 3.0 years following surgery. Repair failure was noted in 68 knees (30.3%)-in 28.1% of knees with fewer than four implants and in 35.8% of knees with four or more implants (p = 0.31). No significant increase in failure was observed with increasing number of all-inside medial (odds ratio [OR]: 1.15; 95% confidence interval [CI]: 0.79-1.7; p = 0.46) or lateral (OR: 0.86; 95% CI: 0.47-1.57; p = 0.63) implants after controlling for patient age, BMI, cACLR, tear type, or size. Tears of the lateral meniscus located in the red-white and white-white zones had lower odds of failure (OR: 0.14; 95% CI: 0.02-0.88; p = 0.036) than tears within the red-red zone, and patients with cACLR had lower odds of repair failure (OR: 0.40; 95% CI: 0.18-0.86, p = 0.024) than those without. The number of all-inside implants placed during meniscus tear repair did not affect the likelihood of repair failure leading to reoperation after controlling for BMI, age, tear type, size, location, and cACLR. LEVEL OF EVIDENCE: III.
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Affiliation(s)
- James D Oosten
- The Ohio State University College of Medicine, Wexner Medical Center, Columbus, Ohio
| | - Alex C DiBartola
- Department of Orthopaedics, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Jonathan C Wright
- The Ohio State University College of Medicine, Wexner Medical Center, Columbus, Ohio
| | - Parker A Cavendish
- Department of Orthopaedics, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Eric M Milliron
- Department of Orthopaedics, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Robert A Magnussen
- Department of Orthopaedics, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Robert A Duerr
- Department of Orthopaedics, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Christopher C Kaeding
- Department of Orthopaedics, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - David C Flanigan
- Department of Orthopaedics, The Ohio State University, Wexner Medical Center, Columbus, Ohio
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Mae T, Nakata K, Yokoi H, Ohori T, Sato S, Hirose T, Uchida R. Knot location in arthroscopic inside-out meniscal repair: Cadaveric evaluation. J Orthop Sci 2024; 29:217-223. [PMID: 36585314 DOI: 10.1016/j.jos.2022.12.006] [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: 11/30/2021] [Revised: 11/10/2022] [Accepted: 12/09/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND The inside-out repair technique is the gold standard for treatment of meniscal tears, while some soft tissues can be hung as the sutures are tied outside the capsule. The purpose was to clarify the association between the suture site and knot location in the arthroscopic inside-out technique. METHODS Inside-out meniscal suture was arthroscopically performed on medial and lateral menisci in twenty-three cadaveric knees, on the assumption that longitudinal tear existed. A retractor was inserted above the semi-membranous tendon and anterior to the gastrocnemius for the medial side, while the retractor was placed in the anterior space of the gastrocnemius for the lateral side. After identifying three segments (anterior, middle and posterior segments), eight sutures were inserted into the following eight areas in each knee: anterior (M1, L1) and posterior (M2, L2) areas of the middle segment, and anterior (M3, L3) and posterior (M4, L4) areas of the posterior segment. Twelve knees underwent meniscal repair on femoral side and eleven passed sutures on the tibial side, while knots were tied outside of the joint. Attentive dissection was performed to assess the relation between knot locations and the principal structures around the knee joint. RESULTS In medial meniscal suture, most sutures for the middle portion (M1, 2) bound medial collateral ligament (MCL), while a few cases included the semi-membranous tendon for the M4 area. In lateral meniscal suture, sutures for the L1 area tied some fibers of lateral collateral ligament (LCL) in high frequency, while popliteal muscles/tendons were tied over at the L3 area. CONCLUSIONS Most suture knots were located on MCL or capsule in medial meniscus suture, while more than half sutures passed through LCL or popliteal tendon/muscle in lateral meniscus suture. An assistant should retract LCL under direct observation and the surgeon must confirm the direction of needle for lateral meniscal repair.
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Affiliation(s)
- Tatsuo Mae
- Department of Sports Medical Biomechanics, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita-city, Osaka, 565-0871, Japan.
| | - Ken Nakata
- Department of Health and Sports Science, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita-city, Osaka, 565-0871, Japan
| | - Hiroyuki Yokoi
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita-city, Osaka, 565-0871, Japan
| | - Tomoki Ohori
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita-city, Osaka, 565-0871, Japan
| | - Seira Sato
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita-city, Osaka, 565-0871, Japan
| | - Takehito Hirose
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita-city, Osaka, 565-0871, Japan
| | - Ryohei Uchida
- Department of Orthopaedic Surgery, Kansai Rosai Hospital, 3-1-69, Inaba-so, Amagasaki-city, Hyogo, 660-8511, Japan
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Owens BD. The Gold Standard. Am J Sports Med 2023; 51:577-578. [PMID: 36856286 DOI: 10.1177/03635465231155446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
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Marigi EM, Till SE, Wasserburger JN, Reinholz AK, Krych AJ, Stuart MJ. Inside-Out Approach to Meniscus Repair: Still the Gold Standard? Curr Rev Musculoskelet Med 2022; 15:244-251. [PMID: 35489016 PMCID: PMC9276857 DOI: 10.1007/s12178-022-09764-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/01/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to provide an up-to-date summary on the current literature and trends regarding use of the inside-out approach to meniscus repair. Additionally, the paper describes the authors preferred techniques for inside-out meniscus repair utilizing posteromedial and posterolateral exposures. RECENT FINDINGS There has been a substantial increase in recent publications regarding meniscus repair. However, comparisons regarding the optimal repair technique have not been conclusive. Despite the recent increase in use of all-inside devices, multiple investigations with short-to-mid-term follow-up have demonstrated similar rates of meniscus healing between inside-out and all-inside repair techniques. Similarly, current literature describes comparable failure rates of around 20%. There are variations in the profile of complications, with all-inside devices having more implant-related complications and inside-out techniques with higher neurovascular injuries. Inside-out meniscus repair is a versatile, cost-effective technique that remains the gold standard for management of most meniscus tear patterns. Through a thoughtful approach, efficient suture retrieval and repair can be performed while protecting critical neurovascular structures. All-inside meniscus repair devices have increased in popularity and surgeon access, but this technique is not without limitations and comparisons to inside-out meniscus repair demonstrates equivocal outcomes.
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Affiliation(s)
- Erick M. Marigi
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905 USA
| | - Sara E. Till
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905 USA
| | - Jory N. Wasserburger
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905 USA
| | - Anna K. Reinholz
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905 USA
| | - Aaron J. Krych
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905 USA
| | - Michael J. Stuart
- Department of Orthopedic Surgery, Mayo Clinic, 200 First St SW, Rochester, MN 55905 USA
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Pace JL, Inclan PM, Matava MJ. Inside-out Medial Meniscal Repair: Improved Surgical Exposure With a Sub-semimembranosus Approach. Arthrosc Tech 2021; 10:e507-e517. [PMID: 33680785 PMCID: PMC7917228 DOI: 10.1016/j.eats.2020.10.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/19/2020] [Indexed: 02/03/2023] Open
Abstract
Inside-out meniscal repair is considered the gold standard for reparable tears of the medial and lateral menisci despite the recent popularity of all-inside devices. Accurate suture passage is required to perform a stable repair as well as to prevent inadvertent neurovascular injury from the suture needles. Placement of a deep soft-tissue retractor is necessary to identify and retrieve these needles prior to tying the sutures. Several authors have recommended placement of this retractor in the interval anterior to the gastrocnemius muscle belly and above the semimembranosus tendon. However, we have noted that the needles often pass distal to the retractor when it is placed in this interval owing to the reorientation of the joint line that occurs with the knee in a relatively extended position during suture placement. We describe a modified technique in which the retractor is placed inferior to the semimembranosus, which puts it directly in line with the needles' trajectory. This modification makes inside-out medial meniscal repair safer and more efficient.
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Affiliation(s)
- J. Lee Pace
- Department of Orthopaedic Surgery, University of Connecticut School of Medicine, Farmington, Connecticut, U.S.A.,Elite Sports Medicine, Connecticut Children’s Medical Center, Farmington, Connecticut, U.S.A
| | - Paul M. Inclan
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri, U.S.A
| | - Matthew J. Matava
- Department of Orthopaedic Surgery, Washington University School of Medicine, St Louis, Missouri, U.S.A.,Address correspondence to Matthew J. Matava, M.D., 14532 S Outer Forty Dr, Chesterfield, MO 63017, U.S.A.
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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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Biomechanical evaluation of arthroscopic all-inside meniscus repairs. Knee Surg Sports Traumatol Arthrosc 2009; 17:1347-53. [PMID: 19629442 DOI: 10.1007/s00167-009-0871-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Accepted: 06/29/2009] [Indexed: 10/20/2022]
Abstract
Viper is a new device for arthroscopically all-inside meniscal repairing. In previous studies about Viper device, procedures were not applied arthroscopically despite this device has been designed for arthroscopic application. In this study, we evaluated primary fixation strength of arthroscopically applied meniscal repair using Viper device to obtain better clinical relevance. Two centimeter in length meniscal tear 2-3 mm far from periferic edge of medial meniscus of 50 calves were created arthroscopically. The menisci were divided into five groups including 10 menisci in each. In group 1, tears were repaired by outside-in vertical loop suture technique with No: 0 PDS. Tears were fixed by all-inside vertical suture by using Viper device with No: 0 PDS in group 2. In meniscal implant groups, RapidLoc, H-Fix, and Clearfix were applied in groups 3,4, and 5, respectively. Primary fixation strength of repairing techniques were evaluated with bio-mechanical testing machine. Fixation strengths determined in groups 1 and 2 were detected as 145 +/- 13 and 136 +/- 33 N, respectively. There was no difference in pull-out strength between groups 1 and 2. Fixation strengths in these two groups were significantly higher compared to groups 3, 4, and 5. There was no significant difference between group 3 (33 +/- 6 N) and 5 (28 +/- 6 N) in terms of fixation strengths whereas fixation strengths of these two groups were significantly higher compared to group 4 (20 +/- 3 N) (P = 0.005, P = 0.018, respectively). All-inside vertical suture technique using Viper device revealed comparable primary fixation strength with outside-in vertical suture technique for meniscal repair. We suggest that the Viper device is safe and reliable for meniscal repair.
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MRI signal changes in completely healed meniscus confirmed by second-look arthroscopy after meniscal repair with bioabsorbable arrows. Knee Surg Sports Traumatol Arthrosc 2009; 17:622-30. [PMID: 19221716 DOI: 10.1007/s00167-009-0728-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2008] [Accepted: 01/16/2009] [Indexed: 10/21/2022]
Abstract
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.
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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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Hospodar SJ, Schmitz MR, Golish SR, Ruder CR, Miller MD. FasT-Fix versus inside-out suture meniscal repair in the goat model. Am J Sports Med 2009; 37:330-3. [PMID: 19029315 DOI: 10.1177/0363546508325667] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Recent all-inside meniscal repair devices are available, but in vivo studies with these devices are sparse. HYPOTHESIS The FasT-Fix has inferior meniscal healing compared with the inside-out suture technique in the goat model. STUDY DESIGN Controlled laboratory study. METHODS After Institutional Review Board approval, 73 male castrated goats (Capra hircus) underwent a 2-cm meniscal incision and subsequent repair with the FasT-Fix device on one knee and inside-out meniscal repair on the contralateral knee. Both repairs used a vertical mattress suture technique. Access to the menisci was via an open technique with an extra-articular osteotomy of the medial collateral ligament origin on the femur. The animals were then allowed to ambulate unrestricted in a pasture after a 7-day stay in cages. Necropsy was carried out 6 months postoperatively, and the menisci and articular cartilage were studied with gross and microscopic inspection. RESULTS Nine of the 73 animals were excluded before necropsy. A total of 64 animals underwent necropsy, gross measurement of residual lesions, gross evaluation for chondral damage, histologic evaluation of meniscal repair, histologic evaluation of any adjacent inflammatory reaction to implants, and data analysis. Compared with the inside-out group, the FasT-Fix group had longer residual full-thickness defects (1.2 +/- 2.9 mm vs 0.2 +/- 1.1 mm; P = .011) and longer residual partial-thickness defects (8.4 +/- 6.3 mm vs 3.6 +/- 5.5 mm; P < .001). A total of 148 FasT-Fix devices were placed for 73 knees. Two devices were replaced for improper deployment. The device deployed and attached correctly 146 of 148 times for a success rate of 98.6%. There was no gross chondral damage and no histologic findings of inflammatory reaction to the implants with either technique. CONCLUSIONS The FasT-Fix meniscal repair had inferior meniscal healing results in this animal model. Previous studies using this animal model have paralleled clinical outcomes. Implantation of the FasT-Fix device does not damage adjacent femoral or tibial cartilage. The deployment of the FasT-Fix implant was simple and reproducible. There was no inflammatory reaction to the FasT-Fix implant. CLINICAL RELEVANCE The FasT-Fix meniscal repair has inferior meniscal healing results compared with the inside-out meniscal repair technique in the goat model. The clinical significance of this finding is not known. Further clinical study of the FasT-Fix implant is warranted.
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Affiliation(s)
- Steven J Hospodar
- Department of Orthopaedics, Wilford Hall Medical Center, Lackland Air Force Base, Texas, USA.
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Staerke C, Kopf S, Becker R. The extent of laceration of circumferential fibers with suture repair of the knee meniscus. Winner of the AGA DonJoy award 2006. Arch Orthop Trauma Surg 2008; 128:525-30. [PMID: 18064476 DOI: 10.1007/s00402-007-0533-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2007] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Cannulas used with suture based meniscal repair techniques can potentially injure the load transmitting fibers of the meniscus. The subject of this study was to quantify this effect in a porcine in vitro model. MATERIALS AND METHODS From fresh frozen medial porcine menisci tissue specimens were harvested following the course of the peripheral circumferential fibers bundles. In the first part of the study the tissue samples were perforated with the cannulas of either a Fast Fix or a Rapidloc device or with an 18-gauge needle. The specimens were then visually inspected for fiber damage using low power microscopy and the mean size of the laceration was measured. Finally, the extent of the tissue laceration was indirectly determined using non-contact strain measurements of the samples before and after puncture. RESULTS When advanced with the cutting edge perpendicular to the fibers, the cannulas consistently cut the fibers while those were rather separated with the opposite orientation. It could be shown that specimens with a mean width of 8.1 mm lost 25% of the load transmitting cross section when being perforated two times with a Fast Fix device (P < 0.001). This effect is negated when the cannula was oriented in line with the fibers. CONCLUSIONS Cannulas used for suture based meniscal repair can cause a substantial laceration of the meniscal tissue. The effect strongly depends on the orientation of the cutting edge of the cannula relative to the course of the fibers and can thus potentially be avoided by an appropriate handling and design.
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Affiliation(s)
- Christian Staerke
- Department of Orthopaedic Surgery, Otto-von-Guericke University Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany.
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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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Choi NH. Meniscal repair for anterior horn tear of the lateral meniscus. Arthroscopy 2006; 22:1132.e1-2. [PMID: 17027413 DOI: 10.1016/j.arthro.2006.01.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2005] [Revised: 10/30/2005] [Accepted: 01/31/2006] [Indexed: 02/02/2023]
Abstract
This technical note describes all-inside meniscal repair for anterior horn tears of the lateral meniscus. A modified anteromedial portal is created for use in visualizing the anterior horn of the lateral meniscus. A crescent-shaped suture hook loaded with a polydioxanone suture (PDS) is inserted through an anterolateral portal. The hook tip penetrates the meniscal peripheral rim and advances across the tear. The suture hook penetrates the mobile central fragment. A leading limb of the PDS is advanced into the knee joint. Then, the leading limb of the suture is retrieved back to the anterolateral portal. With 2 limbs of PDS, endoscopic knot tying is done. With this simple technique, vertically oriented all-inside meniscal repair of an anterior horn tear of the lateral meniscus with the use of absorbable suture materials is easily performed.
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Affiliation(s)
- Nam-Hong Choi
- Department of Orthopaedic Surgery, Eulji Medical Center, Seoul, Korea.
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Lee GP, Diduch DR. Deteriorating outcomes after meniscal repair using the Meniscus Arrow in knees undergoing concurrent anterior cruciate ligament reconstruction: increased failure rate with long-term follow-up. Am J Sports Med 2005; 33:1138-41. [PMID: 16000655 DOI: 10.1177/0363546505275348] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND An increased awareness of the degenerative changes that occur in the knee after meniscectomy has led to efforts to salvage the injured meniscus. Numerous devices have been developed in an effort to provide the dual benefits of a durable meniscal repair and minimal invasiveness. HYPOTHESIS The Meniscus Arrow is comparable to conventional inside-out suture repair in accomplishing long-term healing of meniscal tears. STUDY DESIGN Case series; Level of evidence, 4. METHODS This study is an extended follow-up of an original series of 32 patients with outcomes analysis. All patients underwent meniscal repair with exclusive use of the arrow. All repairs were performed in the context of a concomitant anterior cruciate ligament reconstruction. Follow-up assessment included physical examination, arthrometry, the International Knee Documentation Committee instrument, and the Knee Disorders Subjective History visual analog scale. Intermediate follow-up at a mean of 2.3 years yielded a success rate of 90.6%. The mean follow-up in the present study has been extended to 6.6 years. RESULTS The extended follow-up analysis revealed a substantial attrition in the success rate of this series of patients undergoing meniscal repair with the arrow. A 90.6% success rate at a mean follow-up of 2.3 years deteriorated to 71.4% at 6.6 years. CONCLUSION This study provides the longest follow-up in the literature of any of the all-inside meniscal repair implants. The Meniscus Arrow demonstrated long-term meniscal healing rates inferior to those found in the literature for inside-out suture repair techniques.
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Affiliation(s)
- Gregory P Lee
- University of Virginia, Box 800159, Charlottesville, VA 22908, USA
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Abstract
PURPOSE The all-inside technique using the Meniscus Arrow (Bionx Implants, Malvern, PA) has become a popular method for repairing meniscal tears. The few published clinical studies have been promising. The present study, with longer follow-up and larger numbers, does not show encouraging results. The clinical efficacy, failure rate, and associated complications of meniscal repair using the Meniscus Arrow with a minimum follow-up of 3 years are described. TYPE OF STUDY Consecutive case series. METHODS We studied 60 consecutive meniscal repairs in 57 patients (average age, 27 years) using exclusively the Meniscus Arrow. Follow-up averaged 54 months (range, 36 to 70 months). The anterior cruciate ligament (ACL) was intact in 12 knees (12 repairs), whereas 42 patients (45 repairs) underwent concomitant ACL reconstruction. One patient (2 repairs) had radiofrequency shrinkage of the ACL and another patient (1 repair) underwent concomitant arthroscopic fixation of a tibial eminence fracture. RESULTS Seventeen of 60 repairs (28%) were documented as failures by repeat arthroscopy or magnetic resonance imaging; 5 of 12 repairs (42%) performed in knees with an intact ACL failed; and 9 of 45 menisci (20%) repaired in conjunction with an ACL reconstruction also failed. The remaining 3 failures occurred in knees with unsuccessful ACL procedures. The type of meniscus tear and the postoperative rehabilitation regimen were also factors that influenced the success rate in this study. Fifteen patients (26%) underwent a second operation because of persistent postoperative symptoms. One patient, whose repair failed, deferred a repeat operation after sustaining a postoperative pulmonary embolism. CONCLUSIONS Contrary to previously published studies that reported good clinical results, this series revealed a 28% failure rate with significant postoperative complications, such as chondral scoring, fixator breakage, and postoperative joint-line irritation. This study has raised concerns about the continued liberal use of the Bionx Meniscus Arrow, leading the authors to abandon its use for repairing meniscal tears. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Peter R Kurzweil
- Southern California Center for Sports Medicine, Long Beach, California 90806, USA.
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Miller MD, Kline AJ, Jepsen KG. "All-inside" meniscal repair devices: an experimental study in the goat model. Am J Sports Med 2004; 32:858-62. [PMID: 15150030 DOI: 10.1177/0363546503260068] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although the use of "all-inside" absorbable meniscal repair devices has become popular, numerous complications have been reported. The authors applied their well-established goat model to evaluate three "all-inside" meniscal repair devices. METHODS A "tear" was created in the medial meniscus of both knees in 26 goats. The animals were randomized into four groups, and the meniscus was treated as follows: (A) meniscal repair with Mitek Fastner, (B) meniscal repair with BioStinger, (C) meniscal repair with Mitek Clearfix Screw, and (D) no repair. All animals were sacrificed at 6 months postoperatively, and all specimens were carefully evaluated and results recorded and compared with historical results of meniscal repair with suture in this same animal model. RESULTS Meniscal repair results with all three all-inside devices studied were inferior to suture repair. Chondral injury was present in 75% to 100% of repairs with all-inside devices and none of the control specimens. DISCUSSION / CONCLUSION Although new all-inside meniscal repair devices are relatively quick and easy, results may not be as good as with traditional suture techniques. The high rate of chondral injury associated with these devices in the goat model is worrisome for chondral damage in humans, especially in patients with smaller or tighter knees.
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Affiliation(s)
- Mark D Miller
- Department of Orthopaedic Surgery, University of Virginia, PO Box 800159, Charlottesville, VA 22908, USA
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Abstract
Complications after meniscal repair have been associated with inside-out and outside-in techniques. After the introduction of devices for meniscal repair, reports of chondral damage have been increasing. However, meniscal cyst formation after use of suture materials for meniscal repair is a very rare complication. We report a case of meniscal cyst formation after use of nonabsorbable sutures for meniscal repair.
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Affiliation(s)
- Nam-Hong Choi
- Department of Orthopaedic Surgery, Eulji Medical Center, Seoul, South Korea.
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Sgaglione NA, Steadman JR, Shaffer B, Miller MD, Fu FH. Current concepts in meniscus surgery: resection to replacement. Arthroscopy 2003; 19 Suppl 1:161-88. [PMID: 14673437 DOI: 10.1016/j.arthro.2003.10.032] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Nicholas A Sgaglione
- Department of Orthopaedic Surgery, North Shore University Hospital, 800 Community Drive, Manhasset, NY 11030, USA.
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