All-inside meniscal repair

Abstract

All-inside meniscal repair has gained widespread popularity over recent years. The devices and techniques have rapidly evolved, resulting in increased ease of use and reduced surgical times and risk to the neurovascular structures. Despite these advances, inside-out suture repairs remain the current gold standard, with proven long-term results. All-inside techniques must continue to be compared to inside-out meniscal repair.

Keywords: knee injury; meniscal repair; meniscus tear.

Figure 1.

Meniscal repair devices. A, Meniscal Arrow (third generation, Linvatec, Largo, Florida). B, FasT-Fix (fourth generation, Smith & Nephew, Andover, Massachusetts). C, RapidLoc (fourth generation, Mitek, Westwood, Massachusetts) with “backstop” anchor loaded into the curved inserter, attached suture, and “tophat”; note also the silicone hub limiting depth insertion to 13 mm. D, MaxFire (fourth generation, Biomet, Warsaw, Indiana); note the all-suture anchors.

Figure 2.

Chondral damage secondary to meniscal arrows. Note the grooving of the femoral condyle and lack of meniscal healing after the arrows were removed.

Figure 3.

FasT-Fix meniscal repair device. The needle inserter, with both anchors loaded, is in position for the first pass across the meniscus tear.

Figure 4.

A, RapidLoc in place at time of insertion. B, RapidLoc at 4 months with incorporation into the meniscal tissue.

Figure 5.

Loose intra-articular RapidLoc anchor.

Figure 6.

Inside-out meniscal repair supplemented with exogenous fibrin clot. A, the fibrin clot is prepared and delivered into the knee via a cannula. B, fibrin clot in place, inferior to the meniscus, with several vertical mattress sutures in place.