Clinical results of arthroscopic all-inside meniscal repair

Background: The meniscus plays a key role in normal knee function. Recently, meniscal repair has become an important mode treatment for meniscal tears. Compared to open surgery, arthroscopic meniscal repair has become popular because of shorter duration of the surgery, the smaller incision and better accessibility to the torn portion, which is particularly difficult during open Surgery. Inside-out, outside-in, and all-inside arthroscopic techniques are widely used. Arthroscopy by all inside meniscal repair has the lowest neurovascular injury rate. In this study we have evaluated clinical outcomes of arthroscopic all inside menisceal repair technique.Methods: This study prospectively evaluated 24 consecutively treated patients to determine the effectiveness of arthroscopic meniscal repair using the Fast Fix repair system. Average age of patients at the time of surgery was 24.The inclusion criteria for this study were: vertical full thickness tear >10 mm in length; location of the meniscal tear < 6 mm from the menisco-capsular junction, no former meniscus surgery; and no evidence of arthritis during arthroscopy, absence of complex menisceal tear. Anterior cruciate ligament (ACL) deficient knees were reconstructed using a hamstring autograft or BTB graft at the time of the meniscal repair. Follow-up examinations consisted of IKDC score, Lysholm knee score, Tegner activity score.Results: After an average of 2 years follow-up, no symptoms of meniscal tears were found in 22/24 of the cases. For patients with isolated meniscal repair or concurrent ACL reconstruction, IKDC score, Lysholm and Tegner activity scores had significantly improved postoperatively. One patient had retear for which partial medial meniscectomy was done No neurovascular or other major complications were directly associated with the use of this system.Conclusions: Arthroscopic all-inside repair using the all inside device appears to be a safe and effective surgery to preserve meniscus

Sutura do menisco pela técnica all-inside com o dispositivo Fast-Fix

OBJECTIVE:The objective of this study is to evaluate the results and effectiveness of the technique of meniscal repair type all-inside using Fast-Fix device.METHODS:A retrospective cohort study evaluating 22 patients with meniscal surgery between January 2004 and December 2010 underwent meniscal repair technique for all-inside with the Fast-Fix device with or without ACL reconstruction. Function and quality of life outcomes were chosen by the IKDC and Lysholm score, before and postoperatively, and reoperation rates, relying to the time of final follow-up. Statistical analysis was performed using the Student's t test.RESULTS:The mean follow-up was 59 months (16-84). The Lysholm score showed 72% (16 patients) of excellent and good results (84-100 points), 27% (6 patients) fair (65-83 points) and no cases classified as poor (<64 points). According to the IKDC: 81% (18 patients) of excellent and good results (75-100 points), 18% of cases regular (50-75 points) and no patient had poor results (<50 points). There were no failures or complications.CONCLUSION:The technique of meniscal repair type all-inside using the Fast-Fix device is safe and effective for the treatment of meniscal lesions in the red zone or red-white with or without simultaneous ACL reconstruction, with good and excellent results in most patients Level 4 Study.OBJETIVO:Avaliar os resultados e a eficácia da técnica de reparo meniscal tipo all-inside com o uso do dispositivo FasT-Fix.MÉTODOS:Estudo de coorte retrospectivo com avaliação de 22 pacientes com lesão meniscal operados entre janeiro de 2004 e dezembro de 2010, submetidos ao reparo meniscal pela técnica all-inside com o dispositivo FasT-Fix e associados ou não à reconstrução do LCA. Função e qualidade de vida foram os desfechos escolhidos por meio dos questionários de Lysholm e IKDC, pré e pós-operatoriamente, além das taxas de reoperação, relevando-se o tempo de seguimento final. A análise estatística foi feita com o uso do teste t de Student.RESULTADOS:O tempo médio de seguimento foi de 59 meses (16-84). O escore de Lysholm apresentou 73% (16 pacientes) de excelentes e bons resultados (84-100 pontos), 27% (seis pacientes) regulares (65-83 pontos) e nenhum caso classificado como ruim (< 64 pontos). Segundo o IKDC: 82% (18 pacientes) de excelentes e bons resultados (75-100 pontos); 18% de casos regulares (50-75 pontos) e nenhum paciente obteve resultados ruins (< 50 pontos). Não ocorreram falhas ou complicações.CONCLUSÃO:A técnica de reparo meniscal tipo all-inside com o uso do dispositivo FasT-Fix, nos pacientes avaliados, se mostrou eficaz e segura para o tratamento das lesões de menisco na zona vermelha ou zona vermelho-branca associada ou não à reconstrução simultânea do LCA e apresentou resultados bons e excelentes na maioria dos pacientes.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Department of Orthopedics and TraumatologyUNIFESP-EPM Department of Orthopedics and TraumatologyUNIFESP, EPM, Department of Orthopedics and TraumatologyUNIFESP, EPM Department of Orthopedics and TraumatologySciEL

Shear Force at Failure and Stiffness of All-Inside Meniscal Repair Devices

The purpose of this study was to determine the failure load and stiffness of various meniscal repair devices. A total of 61 fresh-frozen porcine menisci (medial and lateral) were used for the study. A 30-mm vertical, full-thickness tear was created and repaired using one of three all-inside fixation devices and one inside–out repair in the vertical mattress pattern. We used the MaxBraid (Biomet, Warsaw, IN) inside–out suture as a control. The other devices tested were the Meniscal Cinch (Arthrex, Naples, FL), Ultra FasT-Fix (Smith & Nephew, Andover, MA), and the MaxFire MarXmen (Biomet, Warsaw, IN). In addition, two devices, MaxFire MarXmen and Ultra FasT-Fix, were tested using a horizontal mattress configuration. Using the vertical mattress pattern, the Meniscal Cinch had the highest average load to failure. The Meniscal Cinch was significantly less stiff than the other three devices (p \u3c 0.04). For the MarXmen and Ultra FasT-Fix, no differences were noted for load to failure between horizontal and vertical mattress patterns. The mode of failure was significantly different when comparing the two different surgical techniques for the MaxFire MarXmen (p = 0.005). The MaxFire MarXmen device produced a significantly stiffer (p  \u3c 0.001) construct when following the manufacturer\u27s instructions (5.8 N/mm) than with the technique used for the other all-inside devices (2.5 N/mm) The Meniscal Cinch had the highest load-to-failure value but the lowest stiffness of the group in the vertical mattress configuration. There was little difference in biomechanical properties between vertical and horizontal repair. Importantly, there was a significant difference in stiffness and failure mode for the MaxFire MarXmen when the manufacturer guidelines were not specifically followed

Unstable Type III Wrisberg-type Lateral Discoid Meniscus: All-inside Arthroscopic Repair:

Background: The Type III Wrisberg-type represents the rarest subtype of discoid meniscus. It exhibits a normal non-discoid "C"-shape with possible posterior horn hypertrophy, but meniscotibial ligaments and capsular restraints are lacking, leading to a clinical scenario of knee pain, popping, and catching due to meniscal hypermobility. Moreover, concomitant tears can be present due to repeated meniscal traumas. Indications: Type III Wrisberg-type lateral discoid meniscus with hypermobility, dislocation, or tear. Technique Description: Through standard arthroscopic portals, the meniscus is reduced in its anatomical position (if displaced). Abnormal mobility and anatomy should be noted. All-inside sutures are used in the posterior horn and body to stabilize the meniscus to the capsule and popliteus tendon. In the case of radial tears, horizontal stitches are used. Results: Patients are expected to return to sport approximately 4 to 5 months after the procedure with relief of pain, popping sensation, and knee locking. Conclusion: Arthroscopic all-inside repair is an effective treatment for unstable and displaced Type III Wrisberg-type lateral discoid meniscus. However, the diagnosis can be challenging, especially without frank meniscal dislocation

Outcome of all-inside second-generation meniscal repair: Minimum five-year follow-up

BACKGROUND: Meniscal repair and preservation are the goal, when possible, of the treatment of meniscal injury. Current research on second-generation all-inside repair systems has been limited to a maximum of three years of follow-up. The purpose of this study was to evaluate the mid-term clinical success (at more than five years) of meniscal repair performed with a second-generation all-inside repair device, both as an isolated procedure and with a concomitant anterior cruciate ligament (ACL) reconstruction. METHODS: This is a retrospective review of patients who underwent meniscal repair with use of the all-inside FAST-FIX Meniscal Repair System (Smith & Nephew Arthroscopy, Andover, Massachusetts) from December 1999 to January 2007. Eighty-three meniscal repairs (in eighty-one patients) were identified, and follow-up data were obtained for seventy-five (90%). Twenty-six (35%) of the meniscal repairs were performed as isolated procedures. Clinical failure was defined as repeat surgical intervention involving resection or revision repair. Clinical outcomes were also assessed with the Knee injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) score, and the Marx activity score. RESULTS: The minimum duration of follow-up was five years (average, seven years). Twelve patients (16%) had failure of the meniscal repair, at an average of forty-seven months (range, fifteen to ninety-five months). The data did not offer enough statistical evidence, at alpha = 0.05, to establish a difference in average patient age, patient sex, or number of sutures utilized between successful repairs and failures. There was no difference in the failure rate between isolated repairs (12%; 95% confidence interval [CI]: −0.76% to 23.76%) and those performed with concurrent ACL reconstruction (18%; 95% CI: 7.47% to 29.13%), and the average time to failure was similar between these two groups (48.1 months versus 46.6 months, p = 0.939). Postoperative KOOS and IKDC outcome scores were also similar between the groups. CONCLUSIONS: This report of mid-term follow-up results of primary second-generation all-inside meniscal repair demonstrates its effectiveness both as an isolated procedure and when it is performed with concurrent ACL reconstruction. After a minimum of five years of follow-up, 84% of the patients continued to demonstrate successful repair. Treatment success was further supported by favorable results on patient-based outcome measures. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence

Arthroscopic All-Inside Remplissage Technique With Knotless Tape Bridge for Hill-Sachs Lesions

The arthroscopic remplissage procedure has been described to successfully treat engaging Hill-Sachs lesions and improve shoulder stability. Several variations of this technique have been described, including remplissage with 1 or 2 knotted or knotless anchors, remplissage with double or triple bridging pulleys, and remplissage with or without a subacromial view. However, most techniques use anchors in combination with round sutures. This article describes an allarthroscopic articular knotless remplissage technique using a strong, flat, double-strand suture tape bridge fixed with 2 small anchors under direct joint visualization and reduction of the capsule and infraspinatus without requiring a subacromial view

Outside in and all inside approach for repair of meniscal tears: post-operative subjective evaluation: a retrospective study

Background: Assess clinical outcomes after using outside-in, all-inside or combination of both approaches for meniscal repair. Methods: 86 patients with diagnosed meniscal tears, operated between January 2017 and January 2019 by one surgeon in Northway Clinic, Vilnius and Vilnius Clinical Hospital were surveyed. The meniscal repair techniques used included all-inside, outside-in, or a combination. Clinical outcomes were evaluated using the International Knee Documentation Committee Subjective Knee Evaluation Form, with meniscal retear indicating failure. Ethical approval was deemed unnecessary for this project. Descriptive statistical analyses were performed using IBM SPSS Statistics 29.01. Results: Patients undergoing the outside-in approach scored 89.4±12.5 on the IKDC questionnaire, compared to 88.5±16.6 for all-inside and 82.8±20.3 for both techniques combined (p=0.194). Kaplan–Meier analysis showed a 5.6-year survival rate of 80.9% with the all-inside approach. Subjective knee function assessment indicated scores of 8.50±1.9 for outside-in, 8.49±1.4 for all-inside, and 8.16±1.95 for both techniques. Cox proportional hazards model analysis suggested that older age and higher BMI trended towards reduced reoperation risk (hazard ratio, 0.93 and 0.98; p=0.246 and p=0.832, respectively). Conclusions: Self-reported outcomes in this study evaluated by IKDC questionnaire and subjective function assessment emphasize that both all-inside, outside-in or combination of the techniques provide similar results. All adverse outcomes defined as meniscal retears were observed using all-inside technique

Meniscus tears and repair: assessing failure rates of all-inside and outside-in methods

Meniscal repair procedures are on the rise due to an enhanced understanding of the adverse long-term effects associated with the loss of meniscal tissue. Although meniscal repair has a higher reoperation rates compared to meniscectomy, recent systematic reviews indicate improved long-term outcomes with meniscal repair. Even though there are a lot of studies that compare the results of all-inside and inside-out techniques there are only few that evaluate all-inside and outside-in approaches. This study aims to review the relevant literature on the epidemiology, mechanism of injury, clinical presentation and imaging of meniscus and to compare the failure rates and time to failure of AI and OI meniscal repairs. PubMed and Scopus were searched for studies published between January 2014 and January 2024  reporting on meniscus repair outcomes using “outside-in” or “all-inside” techniques with a minimal duration of 6 months for follow-up. Failure was characterized as the recurrence of clinical symptoms or the need for a meniscal reintervention. Over 50 English-language articles were analyzed between 2000 and 2022. After conducting a review and data analysis, it is observed that the “all-inside” technique is more frequently chosen as a treatment method, possibly due to its simpler execution. Both total and percentage rates of failures are higher using this technique, amounting to 79 cases and reaching 16%, compared to “outside-in” approach, which is less commonly chosen, but has lower frequency of failures totaling 6 cases and 5%.