Biomedical Devices in Meniscal Repair

Harris, Butler; Miller, Mark D.

doi:10.1097/00132585-200609000-00003

Cited by 14 publications

(6 citation statements)

References 102 publications

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“…26,43 The 3 arthroscopic techniques used today are the inside-out repair, outside-in repair, and all-inside repair. Although the inside-out repair remains the gold standard of meniscal repairs because of its proven success in a variety of meniscal zones, 14,15,38 the outside-in technique can be useful for anterior tears that are hard to reach through arthroscopic portals, 21 and the all-inside technique has become increasingly popular since the introduction of the Meniscus Arrow (Bionx Implants Inc) in 1993. 3 The all-inside technique has shown reduced operative times, quicker patient recovery, and fewer potential neurovascular complications, especially with tears of the posterior horn.…”

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confidence: 99%

All-Inside Repair of Bucket-Handle Meniscal Tears: Clinical Outcomes and Prognostic Factors

et al. 2020

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Background: There is no consensus on technique of choice for repair of bucket-handle meniscal tears (BHMTs). Purpose: To determine factors that affect patient outcomes and failure rates in patients undergoing all-inside repairs of BHMTs. Study Design: Systematic review. Methods: A systematic review of 3 databases using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed. All English-language literature from 1993 to 2019 describing clinical outcomes for patients undergoing all-inside BHMT repair with ≥12-month follow-up was reviewed by 2 independent reviewers. Patient characteristics (patient sex, age), intraoperative factors (laterality, concomitant procedures, surgical technique, implants utilized), and postoperative outcomes (failure rates) were analyzed. Study quality was evaluated with the Modified Coleman Methodology Score (MCMS). Results: Fifteen studies (1 level 1, 4 level 3, 10 level 4) with 763 total patients (64% male; average age, 26.4 years [range, 9-58 years]; average follow-up, 39.8 months [range, 12-120 months]) including 396 all-inside BHMT repairs were included. Six devices were used for repair including the Meniscal Repair System, FasT-Fix, Meniscus Arrow, Biofix Arrow, RapidLoc device, and PDS II suture, with failure rates of 13.5%, 22.4%, 27.1%, 42.9%, 45.2%, and 0%, respectively. The overall repair failure rate was 29.3% at an average of 13.0 months (range, 5.0-32.4 months), but 19.0% for devices still in use. The RapidLoc and Biofix Arrow had higher failure rates than other devices ( P = .0003). Women (31%) were less likely to experience a failure than were men (69%) ( P = .03). Longer follow-up duration resulted in higher failure rates (>30 months, 34.4%; <30 months, 23.4%; P = .016). In 4 studies reporting on both all-inside and inside-out repairs, no significant differences in failure rates were observed. No significant differences in failure rates were found between medial and lateral repairs nor repair with and without concurrent anterior cruciate ligament reconstruction ( P > .05 for all). The overall average MCMS was 54.4 ± 12. Conclusion: The overall failure rate after all-inside repair of BHMTs is 29.3% at an average of 13.0 months, with no difference in failure rates between medial and lateral meniscal repairs. The variables shown to negatively affect the failure rates were the RapidLoc and Biofix Arrow, male sex, and longer follow-up duration.

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confidence: 99%

All-Inside Repair of Bucket-Handle Meniscal Tears: Clinical Outcomes and Prognostic Factors

et al. 2020

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“…38,44,45,49-51 While the repair technique evolved from earlier all-open meniscal repairs 44,49,50 to less invasive all arthroscopic inside-out and all-inside meniscal repair techniques, 38,45,51 failure rates stayed at a constant level. Investigators previously reported that patient age, 7 time since injury, 28 complex tears, 11 and ligamentous instability 4 are risk factors for poor clinical outcome of meniscus repair; however, little is known about the effect of perioperative NSAID use.…”

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confidence: 99%

The Effect of Perioperative Ketorolac on the Clinical Failure Rate of Meniscal Repair

Proffen

Nielson

Zurakowski

et al. 2014

Orthopaedic Journal of Sports Medicine

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Background There has been recent interest in the effect of nonsteroidal anti-inflammatory medications on musculoskeletal healing. No studies have yet addressed the effect of these medications on meniscal healing. Hypothesis The administration of ketorolac in the perioperative period will result in higher rates of meniscal repair clinical failure. Study design Cohort study; Level of evidence, 3. Methods A total of 110 consecutive patients underwent meniscal repair at our institution between August 1998 and July 2001. Three patients were lost to follow-up, and the remaining 107 (mean age, 15.9 ± 4.4 years) had a minimum 5-year follow-up (mean follow-up, 5.5 years). Thirty-two patients (30%) received ketorolac perioperatively. The primary outcome measure was reoperation for continued symptoms of meniscal pathology. Asymptomatic patients were evaluated by the International Knee Documentation Committee (IKDC) Subjective Knee Form, Short Form–36 (SF-36) Health Survey, and Knee Outcome Osteoarthritis Score (KOOS). Results Kaplan-Meier survivorship revealed no difference in reoperation rates with and without the administration of perioperative ketorolac (P = .95). There was an overall failure rate of 35% (37/107 patients), with a 34% failure rate in patients receiving ketorolac (11/32 patients). Multivariable Cox regression confirmed that age, duration of symptoms, meniscal tear type, fixation technique, concurrent anterior cruciate ligament repair, and ketorolac usage did not have an impact on the rate of failure (P > .05 for all; ketorolac use, P > .50). Female sex (P = .04) and medial location (P = .01) were predictive of an increased risk for reoperation. Conclusion Failure of meniscal repair was not altered with the administration of perioperative ketorolac. Further work studying the effects of longer term anti-inflammatory use after meniscal repair is necessary before stating that this class of medications has no effect on meniscal healing. Clinical Relevance Results of this study suggest that nonsteroidal anti-inflammatory ketorolac can be administered perioperatively during a meniscal repair procedure to harness its benefits of decreased narcotic requirement, decreased pain, and shorter length of hospital stay without negatively influencing the long-term outcome of the surgery.

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“…Among the three arthroscopic repair methods, the all‐inside repair was the most recently developed, with the expectation of decreasing technical difficulty and operative time 10 . Many devices are currently available 7 , but these are certainly not without shortcomings 13,19–24 . In this age of rapid technological advances, new devices need to be evaluated comprehensively to assure that they are equivalent, if not superior, on biomechanical and clinical grounds to other all‐inside repair devices, as well as to other methods of meniscal repair.…”

Section: Discussionmentioning

confidence: 99%

“…These advantages theoretically lead to fewer neurovascular injuries than occur with the inside‐out and outside‐in techniques. Devices such as staples, arrows, FasT‐fix (Smith & Nephew, Endoscopic Division, Andover, MA, USA) and Rapid‐Loc (DePuy Mitek, Raynham, MA, USA) 7 have emerged with the growing demand for more efficient and effective all‐inside repair devices. Although studies have shown these devices to be efficacious 8–11 , they are not without complications such as aseptic synovitis, chondral injury, cystic hematoma formation, and implant failure 12 .…”

Section: Introductionmentioning

confidence: 99%