Clinical evaluation of meniscus repair with a bioabsorbable arrow: a 2- to 3-year follow-up study

Abstract

In a clinical study with the bioabsorbable Bionx Meniscus Arrow we prospectively evaluated 113 consecutive patients (113 menisci) after all-inside meniscus repair. Repairs were performed in either the medial (80.5%) or lateral (19.5%) posterior horn in the red-red or red-white meniscal zone; 66% of patients underwent concomitant ACL reconstruction. Assessment was based on history, clinical examination, and Lysholm [37] and Cincinnati Knee Scores. After a mean follow-up was 33 months (range 24-43; n=105) 21 (20%) patients showed signs and symptoms consistent with a meniscus tear (16 medial, 5 lateral) and underwent partial meniscectomy. In 11 (52%) of the revised patients concomitant ACL reconstruction was performed; 4 (19%) of revised patients were older than 35 years. In the nonrevised the average Lysholm Score was 92.5 and the average Cincinnati Score 90.4. Two patients showed a distinct femoral cartilage damage. Patient's age did not significantly affect the revision rate. Meniscus repair with the bioabsorbable arrow leads to clinical results comparable to those of traditional suture techniques. When stabilized, patients with concomitant ACL reconstruction showed comparable results to patients without ACL rupture. The simple and time saving all-inside insertion obviates the need for additional incisions and avoids knot tying. A proper tear selection and arrow positioning is necessary and should avoid cartilage damage.

Initial Fixation Strength of Flexible All-Inside Meniscus Suture Anchors in Comparison to Conventional Suture Technique and Rigid Anchors

“…2,10,17 The biomechanical characteristics of the new flexible meniscus suture anchors evaluated in this study were either comparable (RapidLoc) or superior (FastT-Fix) to the biomechanical characteristics of the 10-mm Meniscus Arrow. Therefore, the clinical use of the RapidLoc and the FastTFix can be justified from the biomechanical point of view.…”

“…Other authors, using new rigid anchor techniques with lower biomechanical fixation strengths, have suggested a more careful rehabilitation approach. 2,17 Kohn and Siebert 26 demonstrated that vertical suture techniques are superior to horizontal suture techniques. This finding could be confirmed in many other investigations.…”

“…2 Several other studies also reported good to excellent clinical results after the use of rigid meniscus repair anchors. 17,28 Of concern is the significantly lower load-tofailure strength for these devices when compared to conventional vertical sutures. 5,9,[11][12][13][14]19,29,35,37,44 Complications from these devices include migration into the subcutaneous tissue 28 with the risk of neurological injury, loosening, 28 and articular cartilage damage.…”

Chondral injury due to migration of a Mitek RapidLoc meniscal repair implant after successful meniscal repair: a case report

“…The classic outside-in and inside-out techniques, despite their widespread acceptation and the excellent reported _results, have been associated with a relatively high risk of neurovascular injuries or deep infections [12]. However, the all-inside technique for meniscus repair has gained popularity recently, as it is a safe and fast fixation technique [6].…”

Meniscal Repair and Transplantation: Indications, Techniques, Rehabilitation, and Clinical Outcome

“…However, preservation of meniscal tissue is an over whelming rationale in young active patients and several authors have demonstrated that tears located in the central onethird avascular zone can be successfully repaired. 6,12,58,59,68,80,82,90 sults of meniscal repair using fixators, such as arrows, 22,29,43,48,50,83,84 staples, 49 and all-inside biodegradable screws 32,38,69 ; however, arthroscopicassisted suture repair remains the gold standard and is our preferred method. In addition, we have demonstrated that a rehabilitation program that implements immediate knee motion the first postoperative day after meniscus repair (performed either alone or with anterior cruciate ligament [ACL] reconstruction) is not deleterious to the healing meniscus tissue and prevents knee arthrofibrosis.…”