Good Grip Is Key to All-Inside Meniscal Repair

Many meniscus-preserving arthroscopic treatments for meniscus tears have evolved in recent years, including all-inside repairs. Advantages of all-inside techniques include shorter surgical times and reduced risk of damage to neurovascular tissues. Potential drawbacks include risks of local soft-tissue irritation, chondral injury, synovitis, and implant migration or breakage.

One recent generation of all-inside devices, known as FAST-FIX, consists of two polymer anchors connected by a nonabsorbable polyethylene suture in a preloaded delivery needle. In the July 22, 2015, JBJS Case Connector, Rauck et al. presented two cases in which FAST-FIX anchors came loose postoperatively, causing patients to develop knee pain and mechanical symptoms within two to six months after surgery.

To shed additional light on the anchor pullouts described by Rauck et al., we posted a “Watch” article and spoke with Tim Spalding, FRCS, consultant orthopaedic surgeon at the University Hospital in Coventry, England. Dr. Spalding has used FAST-FIX as his main meniscal-repair system for several years.

To minimize potential risks, Dr. Spalding encouraged surgeons to use the supplied slotted cannula when inserting the FAST-FIX delivery needle. “The slotted cannula helps you manipulate the meniscus and steer the needle to exactly where you want it,” Dr. Spalding said.

Perhaps the most important key to success with FAST-FIX is using it in areas of the meniscus that provide strong holding tissue. According to Dr. Spalding, the best grip site for FAST-FIX anchors is the posterior third of the medial meniscus, while tears of the lateral meniscus, especially those near the popliteal hiatus, represent the biggest grip-hold challenge.

“Anchors are not the magic fix some surgeons think they are,” Dr. Spalding concluded. “When they work, they’re simple, fun to use, and you can suture the meniscus in a few seconds, but this major advance might prompt some surgeons to use it in suboptimal situations or with hasty technique.”

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