FastFix meniscal repair (SS-27)

      From August 2001 until August 2003, 91 menisci in 76 patients were repaired using the FastFix system. ACL reconstruction was performed in 64 patients (85%). Twenty-three patients had significant chondral injuries. One to six sutures (avg. 3.12) sere used in the medial meniscus repairs. One to four sutures (avg. 1.6) were used in the lateral meniscus repairs. Fifty were red/red tears and forty-one were red/white tears. Tear patterns were classified as 71 vertical longitudinal, 12 peripheral detachments, 4 bucket handle, 1 radial, and 3 combines (1 vertical longitudinal and horizontal cleavage, 1 vertical longitudinal and flap, and 1 vertical longitudinal and radial). Patients satisfaction was very high with much less morbidity than an inside out repair. Pitfalls and problems encountered with the procedure were 1) Difficulty in proper suture positioning with the straight delivery system 2) Failure of the fixation to deploy 3) Difficulty in deploying the second fixator 4) Loss of fixation purchase during knot tightening 5) A residual loop in the knot after tightening 6) Failure to reach the rim with the fixator in large bucket handle type fragments. These problems were overcome with 1) The use of a curved inserter 2) Rotating the inserter prior to deploying the fixator 3) Modifying the fixator with a thumb stop 4) Using a smooth continuous pull for initial knot pull down followed by a knot pusher for cinching 5) And not using the device for large thick bucket handle fragments. At an average follow-up of 4.9 months (range 1 month to 4.3 years) two patients required partial meniscectomy (1 at 5 months and 1 at 6 months) for non-healing. No patient had neurovascular complications or fixators palpable under the skin.