It is safe and effective to use all inside meniscal repair devices for posteromedial meniscal ‘ramp’ lesions
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Recently, it has been recognized that meniscocapsular (‘ramp’) lesions of the posterior one-third of the medial meniscus frequently occur during injuries causing ACL rupture, and that these lesions are easily missed at arthroscopy. Furthermore, it is clear that these lesions are biomechanically significant, adding to the deficits caused by ACL rupture, and that their repair can reverse this. The efficacy of an all inside repair technique has been questioned by some authors and by those who advocate a suture shuttle technique via an accessory posteromedial portal. The use of Ultra FastFix and FastFix 360 meniscal repair devices to repair posteromedial meniscocapsular separations was investigated in terms of safe deployment and the effectiveness.
Twenty cadaveric fresh frozen knees were used—ten in each of two groups. A ramp lesion was created using a Beaver knife. The lesion was then repaired with either 4 Ultra FastFix (Smith and Nephew) or 4 FastFix 360 (Smith and Nephew) meniscal repair devices. The knees were put through a standardized loading cycle consisting of 10 Lachman’s tests and ten maximum loading manual anterior drawer tests at 90° of flexion. Each knee was then flexed and extended fully ten times. The specimens were sectioned just proximal to the menisci and each suture anchor identified and its position recorded and photographed.
In the Ultra FastFix group, a single anchor was found to be in an intra-articular position—a failure rate of 2.5%. In the FastFix 360 group, 5 anchors failed—a 12.5% failure rate. In all cases, the anchors were attached to their suture and so not truly loose within the joint.
This study confirms the safe and effective deployment of an all inside repair device for repair of medial meniscal ‘ramp’ lesions, and therefore its use is advocated in treating these difficult lesions. Ultra FastFix had the lower failure rate of 2.5%, which the authors believe is acceptable, and makes this device preferable to the FastFix360.
KeywordsACL Knee Meniscus Meniscal repair
The authors would like to thank Smith and Nephew for providing meniscal repair devices and laboratory time.
Compliance with ethical standards
Conflict of interest
Smith and Nephew have provided financial support for research projects at Imperial College and some of the authors have received payment from Smith and Nephew for teaching.
This project was approved by REC Wales approval 12/WA/0196, ICHTB HTA licence 12275, application number R14136-1A.
Consent was not required as this was a cadaveric study.
Supplementary material 1 (MP4 1121 KB)
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