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J Knee Surg 2024; 37(05): 361-367
DOI: 10.1055/a-2112-8158
Original Article

More Is Not Merrier: Increasing Numbers of All-Inside Implants Do Not Correlate with Higher Odds of Revision Surgery

James D. Oosten 
1   The Ohio State University College of Medicine, Wexner Medical Center, Columbus, Ohio
,
Alex C. DiBartola
2   Department of Orthopaedics, The Ohio State University, Wexner Medical Center, Columbus, Ohio
,
Jonathan C. Wright
1   The Ohio State University College of Medicine, Wexner Medical Center, Columbus, Ohio
,
Parker A. Cavendish
2   Department of Orthopaedics, The Ohio State University, Wexner Medical Center, Columbus, Ohio
,
Eric M. Milliron
2   Department of Orthopaedics, The Ohio State University, Wexner Medical Center, Columbus, Ohio
,
Robert A. Magnussen
2   Department of Orthopaedics, The Ohio State University, Wexner Medical Center, Columbus, Ohio
,
Robert A. Duerr
2   Department of Orthopaedics, The Ohio State University, Wexner Medical Center, Columbus, Ohio
,
Christopher C. Kaeding
2   Department of Orthopaedics, The Ohio State University, Wexner Medical Center, Columbus, Ohio
,
David C. Flanigan
2   Department of Orthopaedics, The Ohio State University, Wexner Medical Center, Columbus, Ohio
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Abstract

The purpose of this study was to evaluate the relationship between the number of all-inside meniscal repair implants placed and the risk of repair failure. We hypothesized that the use of higher numbers of all-inside meniscus repair implants would be associated with increased failure risk. A retrospective chart review identified 351 patients who underwent all-inside meniscus repair between 2006 and 2013 by a sports medicine fellowship–trained orthopaedic surgeon at a single institution. Patient demographics (age, body mass index [BMI], sex) and surgical data (number of implants used, concomitant anterior cruciate ligament reconstruction [cACLR], and tear type/size/location) were recorded. Patients who received repairs in both menisci or who had follow-up < 1-year postoperatively were excluded. Repair failure was identified through chart review or patient interviews defined as a revision surgery on the index knee such as partial meniscectomy, total knee arthroplasty, meniscus transplant, or repeat repair. Logistic regression modeling was utilized to evaluate the relationship between the number of implants used and repair failure. A total of 227 all-inside meniscus repairs were included with a mean follow-up of 5.0 ± 3.0 years following surgery. Repair failure was noted in 68 knees (30.3%)—in 28.1% of knees with fewer than four implants and in 35.8% of knees with four or more implants (p = 0.31). No significant increase in failure was observed with increasing number of all-inside medial (odds ratio [OR]: 1.15; 95% confidence interval [CI]: 0.79–1.7; p = 0.46) or lateral (OR: 0.86; 95% CI: 0.47–1.57; p = 0.63) implants after controlling for patient age, BMI, cACLR, tear type, or size. Tears of the lateral meniscus located in the red–white and white–white zones had lower odds of failure (OR: 0.14; 95% CI: 0.02–0.88; p = 0.036) than tears within the red–red zone, and patients with cACLR had lower odds of repair failure (OR: 0.40; 95% CI: 0.18–0.86, p = 0.024) than those without. The number of all-inside implants placed during meniscus tear repair did not affect the likelihood of repair failure leading to reoperation after controlling for BMI, age, tear type, size, location, and cACLR.

Level of Evidence III.

Keywords

meniscus - arthroscopy - implants - repair - treatment failure - suture technique

Disclosures

The authors received no funding for this study and report no conflicts of interest.


Ethical Committee Approval

This study was approved by the Biomedical Institutional Review Board of The Ohio State University.




Publication History

Received: 07 October 2022

Accepted: 16 June 2023

Accepted Manuscript online:
19 June 2023

Article published online:
18 July 2023

© 2023. Thieme. All rights reserved.

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  • References

  • 1 Garrett Jr WE, Swiontkowski MF, Weinstein JN. et al. American Board of Orthopaedic Surgery Practice of the Orthopaedic Surgeon: Part-II, certification examination case mix. J Bone Joint Surg Am 2006; 88 (03) 660-667
    PubMedGoogle Scholar
  • 2 Seitz AM, Lubomierski A, Friemert B, Ignatius A, Dürselen L. Effect of partial meniscectomy at the medial posterior horn on tibiofemoral contact mechanics and meniscal hoop strains in human knees. J Orthop Res 2012; 30 (06) 934-942
    CrossrefPubMedGoogle Scholar
  • 3 Baratz ME, Fu FH, Mengato R. Meniscal tears: the effect of meniscectomy and of repair on intraarticular contact areas and stress in the human knee. A preliminary report. Am J Sports Med 1986; 14 (04) 270-275
    CrossrefPubMedGoogle Scholar
  • 4 Fairbank TJ. Knee joint changes after meniscectomy. J Bone Joint Surg Br 1948; 30B (04) 664-670
    CrossrefPubMedGoogle Scholar
  • 5 Lynch MA, Henning CE, Glick Jr KR. Knee joint surface changes. Long-term follow-up meniscus tear treatment in stable anterior cruciate ligament reconstructions. Clin Orthop Relat Res 1983; (172) 148-153
    PubMedGoogle Scholar
  • 6 Englund M, Lohmander LS. Risk factors for symptomatic knee osteoarthritis fifteen to twenty-two years after meniscectomy. Arthritis Rheum 2004; 50 (09) 2811-2819
    CrossrefPubMedGoogle Scholar
  • 7 Chatain F, Adeleine P, Chambat P, Neyret P. Société Française d'Arthroscopie. A comparative study of medial versus lateral arthroscopic partial meniscectomy on stable knees: 10-year minimum follow-up. Arthroscopy 2003; 19 (08) 842-849
    CrossrefPubMedGoogle Scholar
  • 8 Rosso C, Müller S, Buckland DM. et al. All-inside meniscal repair devices compared with their matched inside-out vertical mattress suture repair: introducing 10,000 and 100,000 loading cycles. Am J Sports Med 2014; 42 (09) 2226-2233
    CrossrefPubMedGoogle Scholar
  • 9 Lee YHD, Nyland J, Burden R, Caborn DNM. Cyclic test comparison of all-inside device and inside-out sutures for radial meniscus lesion repair: an in vitro porcine model study. Arthroscopy 2012; 28 (12) 1873-1881
    CrossrefPubMedGoogle Scholar
  • 10 Nelson CG, Bonner KF. Inside-out meniscus repair. Arthrosc Tech 2013; 2 (04) e453-e460
    CrossrefPubMedGoogle Scholar
  • 11 Noyes FR, Barber-Westin SD. Arthroscopic repair of meniscal tears extending into the avascular zone in patients younger than twenty years of age. Am J Sports Med 2002; 30 (04) 589-600
    CrossrefPubMedGoogle Scholar
  • 12 Cinque ME, DePhillipo NN, Moatshe G. et al. Clinical outcomes of inside-out meniscal repair according to anatomic zone of the meniscal tear. Orthop J Sports Med 2019; 7 (07) 2325967119860806
    CrossrefPubMedGoogle Scholar
  • 13 Baena AE, Castilla BM, Fernandez JS, de Rota Conde AF, Reina AE, Rubio FE. Inside-out medial meniscus suture: an analysis of the risk of injury to the popliteal neurovascular bundle. Arthroscopy 2011; 27 (04) 516-521
    CrossrefPubMedGoogle Scholar
  • 14 Fillingham YA, Riboh JC, Erickson BJ, Bach Jr BR, Yanke AB. Inside-out versus all-inside repair of isolated meniscal tears: an updated systematic review. Am J Sports Med 2017; 45 (01) 234-242
    CrossrefPubMedGoogle Scholar
  • 15 Kang D-G, Park Y-J, Yu J-H, Oh J-B, Lee D-Y. A systematic review and meta-analysis of arthroscopic meniscus repair in young patients: comparison of all-inside and inside-out suture techniques. Knee Surg Relat Res 2019; 31 (01) 1-11
    CrossrefPubMedGoogle Scholar
  • 16 Morgan CD. The “all-inside” meniscus repair. Arthroscopy 1991; 7 (01) 120-125
    CrossrefPubMedGoogle Scholar
  • 17 Ellermann A, Siebold R, Buelow JU, Sobau C. Clinical evaluation of meniscus repair with a bioabsorbable arrow: a 2- to 3-year follow-up study. Knee Surg Sports Traumatol Arthrosc 2002; 10 (05) 289-293
    CrossrefPubMedGoogle Scholar
  • 18 Doig T, Fagan P, Frush T, Lovse L, Chen C, Lemos S. The all-inside all-suture technique demonstrated better biomechanical behaviors in meniscus radial tear repair. Knee Surg Sports Traumatol Arthrosc 2020; 28 (11) 3606-3612
    CrossrefPubMedGoogle Scholar
  • 19 Albrecht-Olsen P, Kristensen G, Burgaard P, Joergensen U, Toerholm C. The arrow versus horizontal suture in arthroscopic meniscus repair. A prospective randomized study with arthroscopic evaluation. Knee Surg Sports Traumatol Arthrosc 1999; 7 (05) 268-273
    CrossrefPubMedGoogle Scholar
  • 20 Barber FA, Herbert MA, Bava ED, Drew OR. Biomechanical testing of suture-based meniscal repair devices containing ultrahigh-molecular-weight polyethylene suture: update 2011. Arthroscopy 2012; 28 (06) 827-834
    CrossrefPubMedGoogle Scholar
  • 21 Albertoni LJB, Schumacher FC, Ventura MHA. et al. Meniscal repair by all-inside technique with Fast-Fix device. Rev Bras Ortop 2013; 48 (05) 448-454
    PubMedGoogle Scholar
  • 22 Venjakob AJ, Föhr P, Henke F. et al. Influence of sutures on cartilage integrity: do meniscus sutures harm cartilage? An experimental animal study. Arthroscopy 2019; 35 (05) 1509-1516
    CrossrefPubMedGoogle Scholar
  • 23 Haas AL, Schepsis AA, Hornstein J, Edgar CM. Meniscal repair using the FasT-Fix all-inside meniscal repair device. Arthroscopy 2005; 21 (02) 167-175
    CrossrefPubMedGoogle Scholar
  • 24 Kalliakmanis A, Zourntos S, Bousgas D, Nikolaou P. Comparison of arthroscopic meniscal repair results using 3 different meniscal repair devices in anterior cruciate ligament reconstruction patients. Arthroscopy 2008; 24 (07) 810-816
    CrossrefPubMedGoogle Scholar
  • 25 Kotsovolos ES, Hantes ME, Mastrokalos DS, Lorbach O, Paessler HH. Results of all-inside meniscal repair with the FasT-Fix meniscal repair system. Arthroscopy 2006; 22 (01) 3-9
    CrossrefPubMedGoogle Scholar
  • 26 Barber FA, Schroeder FA, Oro FB, Beavis RC. FasT-Fix meniscal repair: mid-term results. Arthroscopy 2008; 24 (12) 1342-1348
    CrossrefPubMedGoogle Scholar
  • 27 Turman KA, Diduch DR. Meniscal repair: indications and techniques. J Knee Surg 2008; 21 (02) 154-162
    Article in Thieme ConnectPubMedGoogle Scholar
  • 28 Stärke C, Kopf S, Petersen W, Becker R. Meniscal repair. Arthroscopy 2009; 25 (09) 1033-1044
    CrossrefPubMedGoogle Scholar
  • 29 Grant JA, Wilde J, Miller BS, Bedi A. Comparison of inside-out and all-inside techniques for the repair of isolated meniscal tears: a systematic review. Am J Sports Med 2012; 40 (02) 459-468
    CrossrefPubMedGoogle Scholar
  • 30 Anderson K, Marx RG, Hannafin J, Warren RF. Chondral injury following meniscal repair with a biodegradable implant. Arthroscopy 2000; 16 (07) 749-753
    CrossrefPubMedGoogle Scholar
  • 31 Sonnery-Cottet B, Mortati R, Gadea F, Thaunat M, Moyere F, Chouteau J. Osteolysis of the tibial plateau after meniscal repair with hybrid suture anchor. Knee Surg Sports Traumatol Arthrosc 2013; 21 (09) 2137-2140
    CrossrefPubMedGoogle Scholar
  • 32 Kumar A, Malhan K, Roberts SNJ. Chondral injury from bioabsorbable screws after meniscal repair. Arthroscopy 2001; 17 (08) 34
    CrossrefPubMedGoogle Scholar
  • 33 Lee GP, Diduch DR. Deteriorating outcomes after meniscal repair using the Meniscus Arrow in knees undergoing concurrent anterior cruciate ligament reconstruction: increased failure rate with long-term follow-up. Am J Sports Med 2005; 33 (08) 1138-1141
    CrossrefPubMedGoogle Scholar
  • 34 Menche DS, Phillips GI, Pitman MI, Steiner GC. Inflammatory foreign-body reaction to an arthroscopic bioabsorbable meniscal arrow repair. Arthroscopy 1999; 15 (07) 770-772
    CrossrefPubMedGoogle Scholar
  • 35 Ménétrey J, Seil R, Rupp S, Fritschy D. Chondral damage after meniscal repair with the use of a bioabsorbable implant. Am J Sports Med 2002; 30 (06) 896-899
    CrossrefPubMedGoogle Scholar
  • 36 Cohen SB, Boyd L, Miller MD. Vascular risk associated with meniscal repair using Rapidloc versus FasT-Fix: comparison of two all-inside meniscal devices. J Knee Surg 2007; 20 (03) 235-240
    Article in Thieme ConnectPubMedGoogle Scholar
  • 37 Miller MD, Kline AJ, Gonzales J, Beach WR. Pitfalls associated with FasT-Fix meniscal repair. Arthroscopy 2002; 18 (08) 939-943
    CrossrefPubMedGoogle Scholar
  • 38 Turman KA, Diduch DR, Miller MD. All-inside meniscal repair. Sports Health 2009; 1 (05) 438-444
    CrossrefPubMedGoogle Scholar
  • 39 Tachibana Y, Sakaguchi K, Goto T, Oda H, Yamazaki K, Iida S. Repair integrity evaluated by second-look arthroscopy after arthroscopic meniscal repair with the FasT-Fix during anterior cruciate ligament reconstruction. Am J Sports Med 2010; 38 (05) 965-971
    CrossrefPubMedGoogle Scholar
  • 40 Barber-Westin SD, Noyes FR. Clinical healing rates of meniscus repairs of tears in the central-third (red-white) zone. Arthroscopy 2014; 30 (01) 134-146
    CrossrefPubMedGoogle Scholar
  • 41 Ogawa H, Matsumoto K, Sengoku M, Yoshioka H, Akiyama H. Arthroscopic repair of horizontal cleavage meniscus tears provides good clinical outcomes in spite of poor meniscus healing. Knee Surg Sports Traumatol Arthrosc 2020; 28 (11) 3474-3480
    CrossrefPubMedGoogle Scholar
  • 42 Laurendon L, Neri T, Farizon F, Philippot R. Prognostic factors for all-inside meniscal repair. A 87-case series. Orthop Traumatol Surg Res 2017; 103 (07) 1017-1020
    CrossrefPubMedGoogle Scholar
  • 43 Kedgley AE, Saw TH, Segal NA, Hansen UN, Bull AMJ, Masouros SD. Predicting meniscal tear stability across knee-joint flexion using finite-element analysis. Knee Surg Sports Traumatol Arthrosc 2019; 27 (01) 206-214
    CrossrefPubMedGoogle Scholar
  • 44 Tuman J, Haro MS, Foley S, Diduch D. All-inside meniscal repair devices and techniques. Expert Rev Med Devices 2012; 9 (02) 147-157
    CrossrefPubMedGoogle Scholar
  • 45 Campbell I. Chi-squared and Fisher-Irwin tests of two-by-two tables with small sample recommendations. Stat Med 2007; 26 (19) 3661-3675
    CrossrefPubMedGoogle Scholar
  • 46 Richardson JTE. The analysis of 2 × 2 contingency tables--yet again. Stat Med 2011; 30 (08) 890-890 , author reply 891–892
    CrossrefPubMedGoogle Scholar
  • 47 Nepple JJ, Dunn WR, Wright RW. Meniscal repair outcomes at greater than five years: a systematic literature review and meta-analysis. J Bone Joint Surg Am 2012; 94 (24) 2222-2227
    CrossrefPubMedGoogle Scholar
  • 48 Saltzman BM, Cotter EJ, Wang KC. et al. Arthroscopically repaired bucket-handle meniscus tears: patient demographics, postoperative outcomes, and a comparison of success and failure cases. Cartilage 2020; 11 (01) 77-87
    CrossrefPubMedGoogle Scholar
  • 49 Brooks KR. Vertical lasso and horizontal lasso sutures for repair of horizontal cleavage and horizontal oblique meniscal tears: surgical technique and indications. Arthrosc Tech 2017; 6 (05) e1767-e1773
    CrossrefPubMedGoogle Scholar
  • 50 Yasunaga T, Kimura M, Kikuchi S. Histologic change of the meniscus and cartilage tissue after meniscal suture. Clin Orthop Relat Res 2001; 387 (387) 232-240
    CrossrefPubMedGoogle Scholar
  • 51 Ramappa AJ, Chen A, Hertz B. et al. A biomechanical evaluation of all-inside 2-stitch meniscal repair devices with matched inside-out suture repair. Am J Sports Med 2014; 42 (01) 194-199
    CrossrefPubMedGoogle Scholar
  • 52 Borden P, Nyland J, Caborn DNM, Pienkowski D. Biomechanical comparison of the FasT-Fix meniscal repair suture system with vertical mattress sutures and meniscus arrows. Am J Sports Med 2003; 31 (03) 374-378
    CrossrefPubMedGoogle Scholar
  • 53 Schlechter JA, Nguyen SV, Fletcher KL. Meniscal repairs in the adolescent knee: can the number of fixation sites improve outcomes?. Orthop J Sports Med 2019; 7 (11) 2325967119881963
    CrossrefPubMedGoogle Scholar
  • 54 Ronnblad E, Barenius B, Engstrom B, Eriksson K. Predictive factors for failure of meniscal repair: a retrospective dual-center analysis of 918 consecutive cases. Orthop J Sports Med 2020; 8 (03) 2325967120905529
    CrossrefPubMedGoogle Scholar
  • 55 Beaufils P, Cassard X. Meniscal repair--SFA 2003 [in French]. Rev Chir Orthop Reparatrice Appar Mot. 2007; 93 (8 Suppl): 5S12-5S13
    CrossrefPubMedGoogle Scholar
  • 56 Westermann RW, Duchman KR, Amendola A, Glass N, Wolf BR. All-inside versus inside-out meniscal repair with concurrent anterior cruciate ligament reconstruction: a meta-regression analysis. Am J Sports Med 2017; 45 (03) 719-724
    CrossrefPubMedGoogle Scholar
  • 57 Majeed H, Karuppiah S, Sigamoney KV, Geutjens G, Straw RG. All-inside meniscal repair surgery: factors affecting the outcome. J Orthop Traumatol 2015; 16 (03) 245-249
    CrossrefPubMedGoogle Scholar
  • 58 Iuchi R, Mae T, Shino K, Matsuo T, Yoshikawa H, Nakata K. Biomechanical testing of transcapsular meniscal repair. J Exp Orthop 2017; 4 (01) 2
    CrossrefPubMedGoogle Scholar
  • 59 Aros BC, Pedroza A, Vasileff WK, Litsky AS, Flanigan DC. Mechanical comparison of meniscal repair devices with mattress suture devices in vitro. Knee Surg Sports Traumatol Arthrosc 2010; 18 (11) 1594-1598
    CrossrefPubMedGoogle Scholar
  • 60 Feng H, Hong L, Geng XS, Zhang H, Wang XS, Jiang XY. Second-look arthroscopic evaluation of bucket-handle meniscus tear repairs with anterior cruciate ligament reconstruction: 67 consecutive cases. Arthroscopy 2008; 24 (12) 1358-1366
    CrossrefPubMedGoogle Scholar
  • 61 Yılmaz S, Cankaya D, Fırat A, Devecı A, Ozkurt B, Bozkurt M. Combined inside-out and all-inside technique in bucket-handle meniscus tears. Acta Ortop Bras 2016; 24 (04) 179-183
    CrossrefPubMedGoogle Scholar