Winter 2001 Newsletter

Over the past three years, a number of new devices to facilitate arthroscopic meniscal repair have become available for use in many parts of the world. While suture has been used successfully since the mid-1980s, the surgeon was usually obligated to make some sort of incision around the knee to either tie the suture or protect vital neural and vascular structures around the knee. The technical demands of successfully repairing the meniscus were sometimes passed over in favor of meniscectomy, which provides an immediate "successful" result.

The Bionix Arrow was the first device shown to successfully secure and repair the meniscus from an all "inside" approach1. This was later followed by the Smith and Nephew T-Fix system that combines suture with a plastic anchor. There are now more than seven different devices available for use in arthroscopic meniscal repair2 in addition to the tried and proven methods with suture. Published reports on clinical series are only available so far with the Arrow and T-Fix devices. Reports related to complications with such devices are also beginning to appear3.

In considering which device may be most likely to affect a successful repair, surgeons should consider the strength of the device, the strength of the meniscal device interface, the accuracy of placement and the potential for complications.

Barber recently reported on the mechanical strength of meniscal repair devices and found four statistical groupings of strength2. The two highest groups were the (1) double vertical stitch and the (2) single vertical stitch. The third highest group included the horizontal stitch, the T-Fix and the Biostinger. The last group included the Arrow and four other devices.

Each of the devices for meniscal repair has a unique method of insertion. The size of the insertion device may limit the ability of the surgeon to either accurately place the device into the meniscus or pass the device between the femur and tibia. Suture and needle techniques are the smallest insertion devices, while the devices that deliver staple type implants are the largest.

After placing a meniscal fixation device, the surgeon must be able to confirm its successful placement and secure apposition of the meniscal tear. Lengthy or complex tears may be optimally repaired by utilizing both suture and meniscal repair device techniques.

Before surgeons can know which of all the devices is the best, clinical studies assessing their effectiveness will have to be completed. In the meantime surgeons should familiarize themselves completely with the use of such devices before implanting them into patients and should consider suture methods as the "gold standard."

References:

1. Albrecht-Olsen P, Kristensen G, Tormala P. Meniscus bucket-handle fixation with an absorbable Biofix tack: Development of a new technique. Knee Surg Sports Traumatol Arthrosc. 1993; 1:104-106.
2. Barber FA, Herbert MA. Meniscal repair devices. Arthroscopy. 2000; 16:613-618.
3. Oliverson TJ, Lintner DM. Biofix arrow appearing as a subcutaneous foreign body. Arthroscopy. 2000; 16:652-655.