A novel arthroscopic all-inside suture technique using the Fast-Fix 360 system for repairing horizontal meniscal tears in young athletes: 3 case reports

Abstract

Rationale: Considering the risk of osteoarthritis following resection of a horizontally torn meniscus of the knee, repairing and preserving the meniscus as much as possible is preferred. We report 3 cases of restoration of horizontally torn menisci using a novel arthroscopic method we have called "all-inside interleaf vertical suture" that afforded preservation.

Patient concerns: The 3 patients (aged 14, 17, and 21 years) had knee pain through sports activity.

Diagnoses: All patients had horizontal tears in the posteromedial part of the meniscus.

Interventions: The method uses Fast-Fix, whereby a first anchor is inserted from the tibial surface of the tear's superior leaflet and a second anchor is inserted from the femoral surface of the tear's inferior leaflet, and the 2 leaflets are closed using vertical suture. In all cases, the suture knots were embedded between the superior leaflet and inferior leaflet, avoiding contact with the articular cartilage, and superior leaflet and inferior leaflet crimping was good.

Outcomes: All 3 were able to resume competing in sport and ≥ 1 year after surgery they had no pain and their postoperative mean Lysholm scores were 99.7. There were no complications or recurrence. On magnetic resonance imaging, the signal intensity of all the horizontal tears was high before surgery but low after surgery, suggesting that the repaired tear was healing.

Lessons: The all-inside interleaf vertical suture procedure is a new surgical technique that can repair posteromedial horizontal meniscal tears of the knee of young people by easy crimping of the superior and inferior leaflets without the suture knots causing complications.

Figure 1

Schematic diagrams of the technique. (A) FF used with the tip curved towards the femur. The FF needle is inserted from the tibial surface of the SL near its free edge. First anchor is placed outside the joint capsule (lined arrow indicates insertion direction of the first anchor needle). (B) FF used with the tip curved towards the tibia. Insertion is from the femoral surface of the IL near its free edge. Second anchor is placed outside the joint capsule (lined arrow indicates the insertion direction of the second anchor needle). (C) When a sliding knot is closed, vertical sutures are placed in the horizontal tear. (D) Sutures are tied and cut with the knots embedded between leaflets when closing the horizontal tear (• indicates knots). FF = Fast-Fix, IL = inferior leaflet of horizontal torn meniscus, JC = joint capsule, SL = superior leaflet of horizontal torn meniscus, 1st = first anchor of FF, 2nd = second anchor of FF).

Figure 2

MRI findings of case 1. (A) Preoperatively, horizontal tear in the medial meniscus in the sagittal plane. (B) Six months postoperatively, in the vicinity of the meniscocapsular attachment of the posteromedial part of the meniscus, the signal intensity was low compared to high before surgery. MRI = magnetic resonance imaging.

Figure 3

Arthroscopic findings of case 1. (A) After minimal partial resection of the degenerative tear about the free edge of the medial meniscus, first anchor is inserted from the tibial surface of the superior leaflet, (B) second anchor is inserted from the femoral surface of the inferior leaflet, (C) the sliding knot is tied and (D) the horizontal tear is closed and the knot is embedded between the leaflets.

Figure 4

MRI findings of case 3. Preoperatively (A) in the sagittal plane and (B) coronal plane, a medial radial tear and a posteromedial horizontal tear in the lateral meniscus. At 4 months postoperatively, (C) in the sagittal plane, and (D) coronal plane, the signal intensity is low in the vicinity of the horizontal tear. MRI = magnetic resonance imaging.

Figure 5

Arthroscopic findings of case 3. (A) Presence of incomplete discoid injury of the lateral meniscus. After saucerization of the degenerated parts and radial tear, first anchor was inserted from the tibial surface of the superior leaflet and (B) second anchor was inserted through the femoral surface of the inferior leaflet, (C) the sliding knot was closed, and (D) the horizontal tear was closed and the knot embedded between the leaflets.