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Clinical results of meniscal repair using the Bionx Arrow (SS-26)

      Purpose: The all-inside technique using the Bionx Arrow has become a popular method for repairing meniscal tears. The few published clinical studies have been promising, although their results were based on relatively small sample sizes and short-term follow-up. The present study, with longer follow-up and larger numbers, does not demonstrate encouraging results. The clinical efficacy, success and failure rates, and associated complications of meniscal repair utilizing the Arrow with a minimum follow-up of three years are described. Type of Study: consecutive series. Materials and Methods: 60 consecutive meniscal repairs (in 57 patients) exclusively utilizing the Arrow were studied. Follow-up averaged 54 months. The average age of the patients was 27 years (range 13–53). The ACL was normal in 12 knees (12 repairs). 42 patients (45 repairs) underwent concomitant ACL reconstruction. One patient (2 repairs) had radiofrequency shrinkage of the ACL. One patient (one repair) underwent concomitant arthroscopic fixation of a tibial eminence fracture. Results: Of the 60 repairs, 17 repairs (28%) were documented as failures by repeat arthroscopy or MRI. 5 of 12 repairs (42%) performed in knees with an intact ACL failed. 9 of 45 menisci (20%) repaired in conjunction with an ACL reconstruction failed. The remaining 3 failures occurred in knees with unsuccessful ACL procedures. 15 out of 57 patients (26%) underwent a second operation because of the failed primary repair, and a 16th patient whose repair had failed deferred a reoperation, as he had sustained a pulmonary embolism after the initial surgery. Conclusions: This consecutive series has the largest sample size with the longest follow-up in the literature. Contrary to previous studies with good clinical results, this series revealed a 28% failure rate and significant postoperative complications such as chondral scoring and fixator breakage. This study raises concerns regarding continued liberal use of the Bionx Arrow, leading the senior author to abandon this technique.