A novel arthroscopic all-inside suture technique using the Fast-Fix 360 system for repairing horizontal meniscal tears in young athletes

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.

Arthroscopic all-inside repair with suture hook for horizontal tear of the lateral meniscus at the popliteal hiatus region: a preliminary report

“…Their postoperative mean Lysholm knee score was 99.7, with absence of pain, complications, and recurrence of meniscus tear. And the MRI signal intensity of all the horizontal tears decreased after surgery, suggesting healing of the repaired tear [15]. A systematic review shows that studies of repaired horizontal cleavage tears show a comparable success rate with repairs of other types of meniscus tears [16].…”

Outcomes of arthroscopic repair using the all-inside inter-leaf vertical suture technique for horizontal meniscal tears sustained in sports

“…[ 18 – 20 , 25 – 29 ] The main inside-out method involves a divergent double vertical suture. [ 30 ] Several all-inside methods have been reported including the bio-absorbable implant method, [ 25 ] methods using all-inside suture instruments (like Fast-Fix), [ 20 , 26 , 29 ] and methods using devices with needles through which sutures pass (suture hook, knee scorpion etc.). [ 31 ] Compared with the all-inside method, the inside-out method has a higher risk of neurovascular injury, requires more skin removal, and is likely to increase the operation time.…”

“…The subjects of this retrospective study were patients who underwent the inter-leaf vertical suture procedure [ 20 ] for horizontal meniscal tears. Meniscus repair was performed in 169 patients at the Kyoto Kuramaguchi Medical Center in Japan between July 2015 and December 2017.…”

“…All patients underwent arthroscopic meniscal repair with the following procedure, which we refer to as the inter-leaf vertical suture technique. [ 20 ] The jagged free edges of the horizontal meniscal tear were debrided as sparingly as possible with a basket punch or shaver to clearly define the border between the superior and inferior leaflets of the tear. An FF with reversed curve needle was used.…”

“…Against this background, we believed that a simple and minimally invasive surgical procedure with sufficient therapeutic effect was necessary. So we developed a new all-inside method utilizing the Fast-Fix (FF) 360 system (Smith & Nephew Endoscopy, Andover, MA), which is referred to as the “inter-leaf vertical suture technique” [ 20 ] for repairing horizontal tears in the posteromedial part of the meniscus. We conjectured that by using this method to repair sports-related horizontal meniscal tears, it may be possible to apply adequate force to the cleaved site to achieve superior meniscal restoration and clinical outcomes.…”