• Sports Medicine Clinical Trials
• Orthopaedic Procedures
• Hip & Knee Conditions

• Orthopaedics
• Sports Medicine
• Orthopaedics Clinical Trials
• Orthopaedic Procedures
• Hip & Knee Conditions

Second-generation suture-based devices for meniscal repair appear to have overcome some of the complications associated with first-generation all-inside designs, but there have been no outcome studies of these second-generation systems beyond 3 years. Ljiljana Bogunovic, MD, Washington University in St. Louis, St. Louis, Missouri, USA, discussed the results of a retrospective review of 83 consecutive meniscus repairs (either isolated or combined with anterior cruciate ligament reconstruction [ACLR]), which reported an 84% success rate with a second-generation all-inside repair system at a minimum of a 5-year follow-up. The success of the repair was similar for isolated repairs and for those performed in conjunction with ACLR. Patient age or sex did not affect the outcome.

Patients were identified by billing records as well as the Multicenter Orthopedic Outcomes Network database. A single sports-fellowship-trained surgeon using the FasT-Fix all-inside repair device performed the repairs arthroscopically. Sutures were placed until the desired stability was achieved. All tears were either longitudinal or bucket-handle in orientation, and involved either the red/red or red/white meniscal zones. Patients with isolated tears were weight bearing as tolerated in a knee immobilizer for 6 weeks postoperatively. Patients with combined ACLR were weight bearing as tolerated without bracing. Failure was defined as repeat surgical intervention requiring revision, repair, or resection. Failure information was obtained by telephone interview and chart review after a minimum of 5 years. Patient-reported outcomes were assessed using Knee Injury and Osteoarthritis Outcome Scores (KOOS), International Knee Documentation Committee (IKDC) Subjective Knee Form scores, and Marx activity scores.

Average follow-up at 7 years (range, 5 to 13) was obtained for 90% of the 81 patients (mean age, 27 years; range, 14 to 54 years). Within the final cohort, there were 26 isolated repairs and 49 repairs combined with ACLR. Time to failure was defined as the interval between index meniscal repair and repeat repair or meniscectomy.

Failed meniscal repairs were noted in 16% (n = 12) of the total cohort at a mean of 47 months (range, 15 to 95). Similar failure rates were noted for medial (18%) and lateral (8.0%) meniscal repairs (p = .744). Isolated repairs failed at a rate of 11.5% (95% CI, –.76 to 23.75) compared with 18.3% (95% CI, 7.5 to 29.1; p = .526) for the combined procedure. Individual failure rates are shown in Table 1. Patient age, sex, number of sutures, length of follow-up, or type of procedure (isolated vs combined) did not affect the meniscal failure rate.

Postoperative KOOS and IKDC scores were similar between the isolated and combined treatment groups. Marx activity scores were significantly (p = .03) higher in patients having isolated meniscus repair compared with those having both meniscus repair and ACLR.

This study is limited by its retrospective nature, a definition of meniscal failure that may underestimate true repair failure, and possible insufficient patient numbers to detect a difference between isolated repairs and those performed with ACLR. Despite this, it is apparent that second-generation all-inside meniscal repair devices improved long-term (> 5 years) failure rates compared with first-generation repair devices and were equal to those of inside-out, out-side-in, and open repairs. Equivalent long-term failure rates were also noted with isolated repairs compared with repairs performed with concurrent ACLR. Meniscal repair with a second-generation all-inside repair system is a reliable technique with good longevity.

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