Meniscal repair using the FasT-Fix all-inside meniscal repair device.

PURPOSE: We performed a prospective study of meniscal repair using a new all-inside suture meniscal repair device to evaluate its clinical efficacy.

TYPE OF STUDY: Prospective case series.

METHODS

The results of 42 meniscal tears in 37 patients who underwent meniscal repair using the FasT-Fix device (Smith & Nephew, Andover, MA) were prospectively evaluated. All cases were performed by 1 surgeon (A.A.S.). Preoperative and follow-up evaluation was performed using the objective and subjective International Knee Documentation Committee (IKDC) criteria as well as Lysholm functional questionnaires. Statistical significance was determined to be P < .05 based on a 2-tailed t test. Relook arthroscopy was performed in 8 patients (9 repairs). Any patient who had a hybrid repair was excluded.

RESULTS

The patient population studied, 37 patients comprising 42 meniscal repairs, had an average age of 27 years (range, 13 to 48 years), and an average follow-up of 24.3 months (range, 22 to 27 months). There were 20 male and 18 female patients with 23 medial and 9 lateral repairs; 5 patients had both menisci repaired. All patients had tears in Cooper radial zones 1 and 2 and, thus, had a peripheral meniscal rim of at least 2 mm. All tears were predominantly in the middle and posterior third of the meniscus and 8 tears extended into the posteriormost aspect of the anterior third of the meniscus. An average of 2.8 suture devices was used (range, 1 to 5), predominantly in a vertical or vertical oblique mattress configuration. Forty-two percent were isolated meniscal injuries and 58% had a concurrent anterior cruciate ligament (ACL) reconstruction. Concomitant procedures were ACL reconstruction in 22, excision of loose body in 1, and excision of a large meniscal cyst in 1. Tear length averaged 2.9 cm (range, 1.5 to 4.5 cm). The success rate by objective IKDC score was 86% (73% normal, 13% nearly normal, and 14% abnormal). Of the 5 clinical failures, 3 were in the isolated group (80% success rate), and 2 were in the ACL group (91% success rate). Both the subjective IKDC and the Lysholm scores statistically improved (IKDC average, 59 preoperative and 92 postoperative; Lysholm average, 69 preoperative and 94 postoperative). There were 8 relook arthroscopies; 5 for failures and 3 for other procedures at which time complete healing was noted. In no case was there articular scuffing from the knots. Removal of a device at the time of surgery was necessary in 5 instances for failure of engagement of the T-Fix bar. An additional FasT-Fix device was then inserted without difficulty in each case. No case of postoperative extra-articular or intra-articular complications was encountered.

CONCLUSIONS

The FasT-Fix suture device affords an all-inside method of meniscal repair using a strong vertical or horizontal mattress suture configuration and appears to be a safe and effective technique for meniscal repair for tears with at least a 2-mm peripheral rim. It has a high success rate and low complication rate and has results comparable to classic suture repair techniques.

LEVEL OF EVIDENCE: Level IV.