Several studies have evaluated the risk of peroneal nerve (PN) injuries in all-inside lateral meniscal repair using standard knee magnetic resonance imaging (MRI) with the 30 degrees flexed knee position which is different from the knee position during actual arthroscopic lateral meniscal repair. The point of concern is “Can the risk of PN injury using standard knee MRIs be accurately determined”. To evaluate and compare the risk of PN injury in all-inside lateral meniscal repair in relation to both borders of the popliteus tendon (PT) using MRIs of the two knee positions in the same patients. Using axial MRI studies with standard knee MRIs and figure-of-4 with joint fluid dilatation actual arthroscopic lateral meniscal repair position MRIs, direct lines were drawn simulating a straight all-inside meniscal repair device from the anteromedial and anterolateral portals to the medial and lateral borders of the PT. The distance from the tip of each line to the PN was measured. If a line touched or passed the PN, a potential risk of iatrogenic injury was noted and a new line was drawn from the same portal to the border of the PN. The danger area was measured from the first line to the new direct line along the joint capsule. In 28 adult patients, the closest distances from each line to the PN in standard knee MRI images were significantly shorter than arthroscopic position MRI images (all p-values < 0.05). All danger areas assessed in the actual arthroscopic position MRIs were included within the danger areas as assessed by the standard knee MRIs. We found that the standard knee MRIs can be used to determine the risk of peroneal nerve injury in arthroscopic lateral meniscal repair, although the risks are slightly overestimated

Meniscal tears are the most common injury in the knee, affecting 66/100,000 people/year. Surgical treatment includes arthroscopic meniscectomy or meniscal repair. Little is known regarding medium-term outcomes following these procedures in isolated meniscal tears. This study aims to quantitatively evaluate patients with meniscal tears, and those who have undergone meniscectomy and meniscal repair using validated patient reported outcome measures (PROMs), further exploring factors which affect surgical outcomes. This observational study screened 334 patients who underwent arthroscopic surgery at South Tyneside Hospital since August 2013. 134 patients with isolated meniscal tears were invited to complete postal PROMs. A combination of patient notes and radiological imaging was used to collect information of interest including age, gender, knee-laterality, injured meniscus, tear pattern, procedure performed, complications, and associated injuries. A total of 115 patients (pre-operative patients with current meniscal tear (n=36), meniscectomy (n=63), meniscal repair (n=16)) were included in the analysis with 96% successful PROM completion. Both meniscectomy and meniscal repairs (mean 55-months follow-up) showed better outcomes than pre-operative patients with meniscal tears. Meniscal repairs demonstrated superior outcomes across all PROMs when compared to meniscectomy, with a greater mean overall KOOS score of 17.2 (p=0.009). Factors including higher pre-operative Kellgren-Lawrence Grade, pre-operative articular cartilage lesions and bilateral meniscectomies were shown to negatively influence outcomes. Both meniscectomy and meniscal repair maintain clinical benefit at mean 55-months follow-up, affirming their use for treatment of meniscal tears. When feasible, meniscal repair should be performed preferentially over meniscectomy in isolated meniscal tears. Identified predictive factors allow adequate treatment stratification in specific patient groups

Abstract. Introduction. The popularity of all-inside meniscal repair devices has led to a shift away from inside-out meniscus repair without comparative studies to support the change. The aim of this study was to compare the failure rate and time to failure of all-inside and inside-out meniscus repair performed in elite athletes. Methodology. A retrospective review was performed of all elite athletes who underwent meniscal repair, with a minimum of two-year follow-up between 2013 and 2019. Repairs were classified as all-inside or inside-out according to the repair technique. Failure was defined as undergoing a subsequent surgery to address a persistent meniscal tear. Results. 192 (135 lateral and 57 medial) meniscal repairs in elite athletes were included and 41 (21%) failed. Medial meniscus tears repaired with the all-inside technique failed at a significantly higher rate (58%) than medial meniscus tears repaired with the inside-out (23%) or lateral meniscus tears repaired with the all-inside (12%) or inside-out (14%) technique (p<.001). At 1 year following repair, 8% of lateral meniscus repairs had failed regardless of technique. Medial meniscus repairs failed at an approximate rate of 15% for inside-out technique and 42% for all-inside technique. By 2 years, approximately 54% of all-inside medial meniscus repairs had failed and by 5 years over 60% of repairs had failed. Conclusion. All-inside medial meniscal repair led to a higher rate of failure compared to inside-out medial or lateral meniscus repair in elite athletes. Medial meniscus repairs failed at a high rate than lateral meniscal repairs

Meniscal repairs are commonly performed during anterior cruciate ligament (ACL) reconstruction. This study aimed to identify the risk factors for meniscal repair failure following concurrent primary ACL reconstruction. Primary ACL reconstructions with a concurrent repair of a meniscal tear recorded in the New Zealand ACL Registry between April 2014 and December 2018 were analyzed. Meniscal repair failure was defined as a patient who underwent subsequent meniscectomy, and was identified after cross-referencing data from the ACL Registry with the national database of the Accident Compensation Corporation (ACC). Multivariate Cox regression was performed to produce hazard ratios (HR) with 95% confidence intervals (CI) to identify the patient and surgical risk factors for meniscal repair failure. 2041 meniscal repairs were analyzed (medial = 1235 and lateral = 806). The overall failure rate was 9.4% (n = 192). Failure occurred in 11.1% of medial (137/1235) and 6.8% of lateral (55/806) meniscal repairs. The risk of medial failure was higher with hamstring tendon autografts (adjusted HR = 2.00, 95% CI 1.23 – 3.26, p = 0.006) and in patients with cartilage injury in the medial compartment (adjusted HR = 1.56, 95% CI 1.09 – 2.23, p = 0.015). The risk of lateral failure was higher when the procedure was performed by a surgeon with an annual case volume of less than 30 ACL reconstructions (adjusted HR = 1.92, 95% CI 1.10 – 3.33, p = 0.021). Age, gender, time from injury-to-surgery and femoral tunnel drilling technique did not influence the risk of meniscal repair failure. When repairing a meniscal tear during ACL reconstruction, the use of a hamstring tendon autograft or the presence of cartilage injury in the medial compartment increases the risk of medial meniscal repair failure. Lower surgeon case volume increases the risk of lateral meniscal repair failure

The goal of this prospective study was to evaluate the results of arthroscopic meniscal repair with the FasT-Fix repair system. Type of study: Prospective case series. Methods: 83 meniscal repairs with the FasT-Fix meniscal repair system in 80 patients with a mean age of 29 years were performed between 2004 and 2008. Concurrent anterior cruciate ligament (ACL) reconstruction was performed in 70% of the cases. All tears were longitudinal and located in the red/red or red/white zone. Criteria for clinical success included absence of joint line tenderness, locking, swelling, and a negative McMurray test. Clinical evaluation included also the Lyscholm knee score, and KT-1000 arthrometry. Results: The average follow-up was 38 months (range, 10–61 months). Six of 83 repaired menisci (7.23%) were considered failures according to our criteria. Therefore, the success rate was 92.77%. Time required for meniscal repair averaged 15 minutes. Postoperatively, the majority of the patients had no restrictions in sports activities. 92% had an excellent or good result according to the Lysholm knee score. Four patients had a restriction of knee joint motion postoperatively, and an arthroscopic arthrolysis was performed in one of them. Analysis showed that, age, length of tear, simultaneous ACL reconstruction, chronicity of injury, and location of tear did not affect the clinical outcome. Conclusions: Our results, shows that arthroscopic meniscal repair with the FasT-Fix repair system provides a high rate of meniscus healing and offers reduction of both the risk of serious neurovascular complications and operative time

Purpose: The goal of this study was the evaluation of arthroscopic meniscal repair results using three different repair devices (RapidLoc of Depuy Mitec, T–Fix of Acufex Microsurgical, and FasT-Fix of Smith& Nephew). Methods: From 2001 to 2006, 265 patients with 280 meniscal tears underwent to meniscal repair using three different all-inside meniscal repair implants (88 patients using RapidLoc, 85 patients using T–Fix, and 92 patients using FasT-Fix). There were 181 medial and 99 lateral tears; 174 tears were located in Cooper radial zone 1 and 106 tears in zone 2. All patients had concurrent anterior cruciate ligament reconstruction. All cases were performed by a single surgeon. Follow-up assessment included clinical examination, arthrometry (KT-1000), the International Knee Documentation Committee (IKDC) criteria, and Lysholm functional questionnaires. Success clinical criteria included absence of joint-line tenderness, swelling, blocking, and negative McMurray and Appley test. Results: Mean follow-up was 26 months (range, 9–36 months). Tear length averaged 2.7 cm (range, 1.2–4.3 cm). An average of 2.4 suture devices was used (1.9 of RapidLoc, 3.1 of T–Fix, and 2.2 of FasT-Fix). Twenty eight menisci repairs were consider as failures according to our criteria (success rate 92.4% for FasT-Fix, 87% for TFix, and 86,5% for RapidLoc). There were 16 re-look arthroscopies for device removal and partial meniscectomy, with 8 patients having failure of meniscal repair in zone 2. Both the subjective Lysholm and IKDC scores were significantly improved, with higher improvement in FasT-Fix patients’ group. Chronicity, location or length of the tear, and patients’ age did not affect the clinical outcome. Conclusions: The compared meniscal repair systems showed comparable clinical results. Meniscal repair systems appeared to be a safe and effective technique providing a high rate meniscus healing in both complex tears and tears located in Cooper radial zone 2

Purpose: The goal of this prospective study was to evaluate the results of arthroscopic meniscal repair with the FasT-Fix repair system. Type of study: Prospective case series. Methods: 83 meniscal repairs with the FasT-Fix meniscal repair system in 80 patients with a mean age of 29 years were performed between 2001 and 2004. Concurrent anterior cruciate ligament (ACL) reconstruction was performed in 70% of the cases. All tears were longitudinal and located in the red/red or red/white zone. Criteria for clinical success included absence of joint line tenderness, locking, swelling, and a negative McMurray test. Clinical evaluation included also the Lyscholm knee score, and KT-1000 arthrometry. Results: The average follow-up was 38 months (range, 24–61 months). Six of 83 repaired menisci (7.23%) were considered failures according to our criteria. Therefore, the success rate was 92.77%. Time required for meniscal repair averaged 15 minutes. Postoperatively, the majority of the patients had no restrictions in sports activities. 92% had an excellent or good result according to the Lysholm knee score. Four patients had a restriction of knee joint motion postoperatively, and an arthroscopic arthrolysis was performed in one of them. Analysis showed that, age, length of tear, simultaneous ACL reconstruction, chronicity of injury, and location of tear did not affect the clinical outcome. Conclusions: Our results, shows that arthroscopic meniscal repair with the FasT-Fix repair system provides a high rate of meniscus healing and offers reduction of both the risk of serious neurovascular complications and operative time

Background. Anterior cruciate ligament (ACL) reconstruction with concomitant meniscal injury occurs frequently. Meniscal repair is associated with improved long-term outcomes compared to resection but is also associated with a higher reoperation rate. Knowledge of the risk factors for repair failure may be important in optimizing patient outcomes. Purpose. This study aimed to identify the patient and surgical risk factors for meniscal repair failure, defined as a subsequent meniscectomy, following concurrent primary ACL reconstruction. Methods. Data recorded by the New Zealand ACL Registry and the Accident Compensation Corporation, the New Zealand Government's sole funder of ACL reconstructions and any subsequent surgery, was reviewed. Meniscal repairs performed with concurrent primary ACL reconstruction was included. Root repairs were excluded. Univariate and multivariate survival analysis was performed to identify the patient and surgical risk factors for meniscal repair failure. Results. Between 2014 and 2020, a total of 3,024 meniscal repairs were performed during concurrent primary ACL reconstruction (medial repair = 1,814 and lateral repair = 1,210). The overall failure rate was 6.6% (n = 201) at a mean follow-up of 2.9 years, with a failure occurring in 7.8% of medial meniscal repairs (142 out of 1,814) and 4.9% of lateral meniscal repairs (59 out of 1,210). The risk of medial failure was higher in patients with a hamstring tendon autograft (adjusted HR = 2.20, p = 0.001), patients aged 21–30 years (adjusted HR = 1.60, p = 0.037) and in those with cartilage injury in the medial compartment (adjusted HR = 1.75, p = 0.002). The risk of lateral failure was higher in patients aged ≤ 20 years (adjusted HR = 2.79, p = 0.021) and when the procedure was performed by a surgeon with an annual ACL reconstruction case volume of less than 30 (adjusted HR = 1.84, p = 0.026). Conclusion. When performing meniscal repair during a primary ACL reconstruction, the use of a hamstring tendon autograft, younger age and the presence of concomitant cartilage injury in the medial compartment increases the risk of medial meniscal repair failure, whereas younger age and low surgeon volume increases the risk of lateral meniscal repair failure

Abstract. Introduction. Augmentation of meniscus repairs with fibrin clot may enhance the healing capacity. Pulling the clot into the tear with a suture ensures that it stays in position. This paper aims to assess the outcome of this technique. Methods. 52 patients over 4 years undergoing suture repair of a meniscus tear with blood clot augmentation were collected from a prospective database. Follow up included outcome scores and a questionnaire. Failure was defined as pain or further surgery secondary to meniscal pathology. Results. There were 32 males and 20 females, mean age of 35 (14–70). The medial meniscus was repaired in 32 knees and the lateral in 20. Complete radial tears were the most common type. Only 2% of tears were in the red-red zone. Follow-up ranged from 12 months to 7 years. Only 1 patient is known to have come to subsequent arthroscopy. Lysholm scores improved from 53.97 (SD 18.14) to 92.08 (SD 8.97), Oxford Knee Scores from 29.84 (SD 9.65) to 45.79 (SD 2.66), KOOS pain scores from 61.49 (SD 22.76) to 93.54 (SD 8.06) and Tegner scores from 4.56 (SD 3.35) to 6.05 (SD 2.41). Conclusions. Pulling a fibrin blood clot into a meniscus tear with a suture ensures that the clot remains in place while the meniscus is repaired. Patients have shown excellent outcomes with 98% survivorship at 45 months. This is a reliable technique for augmenting meniscus repairs especially for tears which otherwise may not have been repaired

Introduction To evaluate the Fast-Fix meniscal repair system, which is a disposable, pre knotted ‘all-inside’ suture with similar pull out strength to vertical mattress suture. Materials and Methods Between September 2001 and May 2002, we performed 39 meniscal repairs in 38 patients, 1 patient had bilateral injury. The average age was 24(16–37). The cause of the meniscal injury was sports related in 70%, unrelated to sports in 16% and with no history of trauma in 14%. The average time from injury to repair was 2–3 weeks. The majority had associated Anterior Cruciate Ligament Rupture 73% (28 patients). 23 patients had medial meniscal and 16 had lateral meniscal repair. All cases were done as a day case by the senior author. The meniscus was repaired, if the tear was vertically oriented and in the periphery. Two Fast-Fix sutures were used for each repair. Concomitant ACL injury was reconstructed 6 weeks post meniscal repair. Meniscus was considered to have healed if a) confirmed at arthroscopy or b) No mechanical symptoms after repair. 31 patients had repeat arthroscopy, 28 for ACL reconstruction, 2 for persistent mechanical symptoms and 1 following re-injury. Results The range of clinical follow up was between 3 to 20 months. In 26 patients healing of the meniscus was confirmed during arthroscopy. 7 patients had no mechanical symptoms following repair. The healing rate was 86% (33 patients). 5 repairs were considered as failures and were excised subsequently. The healing rate was higher in patients with associated ACL injury (92%) compared to isolated meniscal tear healing rate of 70%. Discussion We feel early results show the Fast-Fix to be safe, simple to use all- inside meniscal repair technique and has the advantage of vertical mattress sutures and no separate incision. Healing rates with combined ACL injuries are better than isolated meniscal tears

Purpose: To investigate the validity of previous observations that meniscal repair has a better success rate when associated with ACL reconstruction. Methods and Results: The case notes of 170 patients who underwent meniscal repair between May 1999 and May 2007 were analysed for causes of re-operation and relation to status of the ACL. Mean age at the time of surgery was 28 years. 41 patients underwent re-operation at a mean time interval of 21 months (range 2 weeks - 87 months). 79 patients (Group A) had isolated meniscal tears. 44 patients (Group B) had meniscal repair at the same time as elective ACL reconstruction and underwent brace-free, accelerated rehabilitation. 47 patients (Group C) had meniscal repair in association with ACL disruption and underwent staged ligament reconstruction. In Group A, 23 patients underwent re-operation (Indications; meniscal symptoms 21, stiffness 1, infection 1). Nineteen repairs (23.8%) were found to have failed. In Group B, 15 patients underwent re-operation (Indications; meniscal symptoms 12, stiffness 1, revision ACL 2). Twelve (27.2%) repairs were found to have failed. In Group C, Nine (19.6%) repairs were found to have failed. 6 at the time of staged ACL reconstruction and 3 subsequently, at further arthroscopy. There was no statistical difference between the groups with respect to the incidence of failed meniscal repairs. Analysis of possible predictive factors including age, gender, location of lesion and the type of repair did not show statistical significance. Conclusions: Reoperation rate following meniscal repair is high. Meniscal repair for tears associated with ACL disruption in this group did not appear to have a higher success rate compared to isolated tears. This raises questions regarding the current practice of ignoring meniscal repair and instituting brace-free, early, aggressive rehabilitation following concomitant ACL reconstruction

In the last decades, significant effort has been attempted to salvage the meniscus following injury. Basic science approaches to meniscus repair include procedures for both meniscus regeneration and meniscus healing. Regeneration of meniscal tissue focuses on filling a defect with reparative tissue, which resembles the native structure and function of the meniscus. Procedures for meniscus healing, on the other hand, aim to accomplish adhesion between the margins of a meniscal lesion, with no attempt to regenerate or replace meniscal tissue. Regeneration studies of tissue to fill a defect in the meniscus have shown interesting results, but complete restoration of the native meniscus has not yet been accomplished. Healing of a meniscal lesion has been investigated in different models although none has demonstrated reproducible healing. Therefore, different paths of investigation must be undertaken, and one of these may be the cell-therapy / tissue engineering approach. In a study from our group, we showed the capacity of chondrocyte-seeded cartilaginous scaffold to repair a bucket-handle lesion of the knee meniscus orthotopically in a large animal study. Following studies were done in order to test the potential of other scaffolds and different cell sources for the repair of the meniscal tissue. We have also evaluated the role of hypoxia in meniscal development in vitro as basis for future research in this field, as hypoxia could be be considered as a promoter for meniscal cells maturation, and opens considerably opportunities in the field of meniscus tissue engineering

Purpose: To evaluate the clinical results after meniscal repair using Bionx arrows. Methods: The study reports the clinical results of 50 patients who had meniscal repair. The meniscal repairs were carried out by a single surgeon over a period of 4 years. 30 patients ( 1st set) had isolated meniscal repairs. 9 patients ( 2nd set) had meniscal repairs and ACL reconstruction at the same time. 11 patients (3rd set) had meniscal repair followed by ACL reconstruction few months later. The patients were seen in the clinic at 2, 6, 24 weeks post surgery and then kept under surveillance. Results: In the 1st set , there were only 2 failures who needed partial menisectomy at 7 months and 2 years respectively after the initial repair. So, the failure rate is only 6.6%. There was only 1 failure in the 2nd set who needed partial menisectomy 19 months post repair. This gives it a failure rate of 11.1%. In the 3rd set, there were 2 failures out of whom one needed partial menisectomy and other needed re-repair using the arrows at 3 and 7 months respectively post repair at the time of ACL reconstruction, a failure rate of 18.8%

Aim: To evaluate the effectiveness of all inside meniscal repair technique in treating bucket handle tears of the meniscus in the athletic population. Method: From 2005–2008, 40 patients underwent meniscal repair for bucket handle tear of the meniscus, either as a primary procedure or combined with ACL reconstruction. All patients were contacted by clinical review, letter or telephone retrospectively. All patients were scored using the Tegner Knee score. All patients had been participating in sport at international level, semi professional level or club level. Failure was defined as a recurrence in symptoms necessitating reoperation and success as a return to competitive sport. Results: There were 27 medial meniscal tears and 13 lateral, in 38 knees. The average age was 23 years (16–39). The average length of follow up was 1.5 years (0–2–3.1) years, and the average time from injury to surgery was 47 weeks. 9 patients were treated with fast fix (Smith and Nephew Endoscopy) and 31 Rapidloc (DePuy Mitek). There was an average of 2.85 sutures used. The overall cumulative survival rate at two years was 83.9% (4 Failures). All reoperations were preceded by a subsequent traumatic event to the knee resulting in a recurrence of symptoms. Time to return to sport in patients with associated ACL reconstruction was not affected by conincidental meniscal repair. Of the primary meniscal repairs the time to return to previous sport was less than 4 months. Conclusion: This study shows that meniscal repair has a high success rate for sporting individuals with meniscal tears and has a high chance of the individual returning to competitive sports

Introduction: Meniscal injuries are common and a potential source of osteoarthritis of the knee. This has led to the development of techniques to repair meniscal tears. The goal of this study was to look at the independent variables that have an influence on the outcome and identify factors that might improve future clinical results. Method: A total of 119 meniscal repairs were included in this study and evaluated at minumum 72 months postoperatively (range 72–86). Meniscal repair was done by an arthroscopically assisted technique: inside-out, all-inside or by a combination of both techniques. Patients with menisci repaired were clinically evaluated. We performed examinations using the International Knee Documentation Committee (IKDC) form and the Lysholm score. Radiological analysis of the knees was done by means of the Ahlback classification pre- and postoperatively. Variables that were analyzed were age, gender, type of repair, chronicity of the lesion, zone of injury, morphology of the tear, involvement of the anterior cruciate ligament (ACL), and the compartment involved. Statistical analysis was done by means of logistic regression. Results: The overall clinical success rate for meniscal repair was 74.0%. In 73.1% of the cases, the mensiscal injury was associated with an injury of the ACL. Patients with an associated ACL injury had a better chance for a successfull outcome, but this was only significantly when the ACL injury was repaired (p< 0.05). There was no difference between the male and female patients regarding outcome. A delay in treatment for 6 weeks or more resulted in significantly worse results (p< 0.001). Younger patients had significantly better outcome results (p< 0.05). Better results were obtained when the inside-out technique was used for meniscal repair (p< 0.05). Discussion: Our data confirm the good outcome results of meniscal repair. In our hands, a meniscal repair has the highest likelihood of success in young patients, with a concomitant ACL injury that is repaired at the same time. Better outcome scores were observed when the inside-out technique was used and when menisci where repaired within 6 weeks of the initial injury

Purpose of study: The all inside fixation of meniscal tears with bio-degradable products is popular because of its fast application and reduction in risks of serious neurovascular complications. We reviewed the results of a consecutive series of all inside meniscal repairs performed by the senior author in a carefully selected patient population. Materials & Results: The senior author performed 104 consecutive meniscal repairs (54 lateral & 50 medial meniscus) in 96 patients (66 male, 30 female), using all inside meniscal repair systems (18 Bionxx, 86 FasT Fix; Smith & Nephew). The average patient age at the time of repair was 31.6 years (range 17 – 46 years). On an average 2 arrows (range 1–4) were used in the Bionnx system and 2.5 sutures (range 1–7) for the Fas T fix system. The predominant tear pattern was a peripheral red on white type tear involving the body and posterior horn. Concomitant ACL reconstruction was undertaken in 50% cases. In 26.9 % cases the repaired meniscus was partially trimmed prior to repair and in 25 % cases a tear of the non repaired meniscus was stabilised by trimming alone. A further arthroscopic partial menisectomy was performed in 12 cases of failed repair (4 Bionxx, 8 Fas T fix) at an average of 16.16 months (range 1 month – 44 months). None of the other patients had symptoms or signs suggestive of meniscal pathology on follow up (minimum 12 months). The repair was successful in 90.69 % of Fas T fix repairs and 77.78 % of Bionxx repairs. The meniscal repair failure rate in the group which had an ACL reconstruction was 5.77 %. No major intra or post operative complications were noted. Conclusion: Successful meniscal preservation is feasible by using an all-inside meniscal repair device. Patient selection and due consideration to the site and geometry of the meniscal tear is crucial

The goal of this study was to evaluate the outcomes from arthroscopic “all inside” meniscal repairs using the FasT-Fix suture system, performed at the Gold Coast and Allamanda Private Hospitals during 2006–2007. 40 consecutive meniscal repairs in 36 patients were performed both in isolation and in conjunction with ACL reconstruction. All repairs were performed by the senior author (PG), using an arthroscopic all inside technique with the Fastfix suture anchor system. Patients were assessed at a minimum 6 months follow up, including assessment with the IKDC subjective form. 36 patients underwent a total of 40 meniscal repairs. The average age of the patients was 23.4 years (range 14–42). There were 65% male (26 patients) and 35% female (14 pts). 67.5% (27 menisci) were medial and 32.5% (13 menisci) were lateral repairs. 4 patients underwent bilateral repairs (1 involving 2 different operative dates). 55% (22/40 pts) were right knees and 45% (18/40 pts) were left knees. The average number of FasT-Fix meniscal anchors used was 3.8 (range 1–10). 62.5% (25 pts) underwent concurrent anterior cruciate ligament (ACL) reconstruction. 37.5% (15 pts) were isolated meniscal injuries. 55% (22 pts) had associated chondral surface abnormalities. No Significant complications occurred, including no nerve injuries, infections, or post-operative stiffness. 3 patients underwent subsequent re-operation to resect failed repairs, leaving 37 menisci successfully repaired (92.5%). 5 patients 12.5% described some persistent pain post operation. The average IKDC subjective score for those patients with intact repairs was 91 (62–100). Meniscal repair using an arthroscopic all inside technique provides a safe, reliable and reproducible method of repairing torn menisci, without the need for a further ‘safety incision’ to retrieve and tie sutures. The outcomes from this study indicate that patients demonstrate similar functional results, and low failure rates, similar to other published meniscal repair methods, including the gold standard of inside-out repair

Purpose: Despite a number of recently published reports on the success of meniscal repair devices, there are no anatomic studies documenting their safety. The purpose of this cadaveric and radiographic study was to anatomically determine the proximity of a common commercially available meniscal repair device to the popliteal neurovascular structures. Methods: Five human cadaveric knees were obtained and procured from the medical school anatomy lab. Two Biostingers (Linvatec) measuring 16mm in length were placed in the posterior one third of the medial meniscus. Each specimen was then placed prone with the knee extended to expose the posterior aspect of the knee. The distance to the neurovascular bundle for each device was then measured with a ruler calibrated to the nearest 0.1cm. To validate our anatomic dissection results, fifty calibrated human knee MRI scans were reviewed by two independent radiologists. The distances measured were from the popliteal artery to the closest point at the lateral meniscus periphery/capsule and the medial meniscus periphery/capsule. The average distance as measured by the two radiologists was calculated as was the average for the entire population of fifty subjects. Results: The mean distance in the cadaveric study was 15.6mm (14.0–18.0mm) between the tip of the repair device needle and the neurovascular bundle. The mean distance on MRI from the popliteal neurovascular bundle to the closest point in the posterior medial meniscus was 20.0 mm (13.0 mm–28.7 mm). The mean distance from the popliteal structures to the posterior lateral meniscus was 9.4 mm (3.2 mm–16.5 mm). Conclusions: Considering the potential for significant morbidity, we recommend medial meniscal repair should be performed carefully with repair devices. Specifically, one should limit posterior capsule penetrations to less than 15 mm based on these findings

We have an aggressive approach to meniscal repair, including repairing tears other than those classically suited to repair. Elite athletes represent the subgroup of patients who place the most demand on the menisci and as a result, place maximum stress on any meniscal repair. Here we present the medium to long-term outcome of meniscal repair (inside-out) in the elite athlete. 42 elite athletes underwent 45 meniscal repairs between January 1990 and July 1997 were identified from a prospective database. All repairs were performed using an arthroscopically assisted inside-out technique. All patients returned a completed questionnaire (Lysholm and IKDC) to determine their current function and any symptoms or interventions that we were unaware of. 67% medial and 33% lateral menisci were repaired (3 patients had both medial and lateral menisci repaired). 83.3% of these repairs were associated with simultaneous ACL reconstruction. The average time from injury to surgery was 11 months (range 0–45 months). Follow-up time was a mean of 8.5 years (range 5.4 to 12.6 years). In general, function was good with an average Lysholm and subjective IKDC scores of 89.6 and 85.4 respectively. 81% of patients returned to their main sport and most to a similar level at a mean time of 10.4 months post-repair. We identified 11 definite failures, 10 medial and 1 lateral meniscus that ultimately required arthroscopic excision, this represents a 24% failure rate. We identified one further patient who had possible failed repairs, giving a worse case failure rate of 26.7% at a mean of 42 months post surgery. However, 7 of these failures were associated with a further injury, and 2 of the 7 failures ruptured their ACL reconstruction. Therefore the repairs had healed and were torn with reinjury. In this series medial meniscal repairs were Significantly more likely to fail than lateral meniscal repairs, with a failure rate of 36.4% and 5.6% respectively (p< 0.05). This series reflects an aggressive approach to meniscal repair with repair of tears in a high demand elite group of patients. Despite this, on a worst case analysis 73% were intact at a mean of 8.5 years post repair. We conclude that meniscal repair and healing is possible and that most patients can return to preinjury level of activity

Purpose of the study: The aim of this prospective study was to assess functional outcome one year after meniscal repair and to correlate them with healing as assessed by arthroscan performed systematically at six months. Follow-up was 12 to 28 months. Material and methods: Forty one meniscal repairs were included (28 medial and 13 lateral menisci). There were 33 longitudinal vertical tears, five horizontal cleavages in young athletes, one hypermobile meniscus and two complex lesions. The meniscal repair was associated with ACL reconstruction in 26 cases. In six cases, meniscal repair was an open procedure, in 34 a medial arthroscopic procedure and in one a combined arthroscopic open technique. 71% of the tears were recent, 29% were chronic. Mean length of the lesion was 21 mm. Physical examinations were performed in all patients at six weeks, and 3, 6, and 12 months. The. IKDC score was established preoperatively and at 6 and 12 months. An arthroscan was obtained at six months. Results: There were no neurological complications related to the open approach. In three cases, the suture was loose but without subsequent intra-articular loss. There were no infections. Three patients presented recurrent meniscal tears 12 to 26 months postoperatively: secondary meniscectomy in one and a new repair in another. Therapeutic abstention was proposed for the third (a hypermobile meniscus). Mean subjective IKDC score was 67.0 points preoperatively, 73.2 at six months and 83.6 at one year. Moderate pain persisted at one year in four patients. The six-month arthroscan showed complete or incomplete (but greater than 50%) healing of the meniscal surface in 33 cases and less than 50% healing in 8. Radiologically, healing was similar for medial and lateral repairs. The joint surface was normal in all cases on the plain x-ray. Discussion: AT 12–28 months follow-up, the rate of recurrence was low (3/41), less than in a retrospective review reported by the French Society of Arthroscopy with the same follow-up. The technique has improved. Conclusion: The one-year functional outcome is good. Complete healing as assessed on the arthroscan does not indicate the functional outcome at this follow-up