Original article| Volume 21, ISSUE 8, P905.e1-905.e7, August 2005

Unsatisfactory Clinical Results of Meniscal Repair Using the Meniscus Arrow

      Purpose: The all-inside technique using the Meniscus Arrow (Bionx Implants, Malvern, PA) has become a popular method for repairing meniscal tears. The few published clinical studies have been promising. The present study, with longer follow-up and larger numbers, does not show encouraging results. The clinical efficacy, failure rate, and associated complications of meniscal repair using the Meniscus Arrow with a minimum follow-up of 3 years are described. Type of Study: Consecutive case series. Methods: We studied 60 consecutive meniscal repairs in 57 patients (average age, 27 years) using exclusively the Meniscus Arrow. Follow-up averaged 54 months (range, 36 to 70 months). The anterior cruciate ligament (ACL) was intact in 12 knees (12 repairs), whereas 42 patients (45 repairs) underwent concomitant ACL reconstruction. One patient (2 repairs) had radiofrequency shrinkage of the ACL and another patient (1 repair) underwent concomitant arthroscopic fixation of a tibial eminence fracture. Results: Seventeen of 60 repairs (28%) were documented as failures by repeat arthroscopy or magnetic resonance imaging; 5 of 12 repairs (42%) performed in knees with an intact ACL failed; and 9 of 45 menisci (20%) repaired in conjunction with an ACL reconstruction also failed. The remaining 3 failures occurred in knees with unsuccessful ACL procedures. The type of meniscus tear and the postoperative rehabilitation regimen were also factors that influenced the success rate in this study. Fifteen patients (26%) underwent a second operation because of persistent postoperative symptoms. One patient, whose repair failed, deferred a repeat operation after sustaining a postoperative pulmonary embolism. Conclusions: Contrary to previously published studies that reported good clinical results, this series revealed a 28% failure rate with significant postoperative complications, such as chondral scoring, fixator breakage, and postoperative joint-line irritation. This study has raised concerns about the continued liberal use of the Bionx Meniscus Arrow, leading the authors to abandon its use for repairing meniscal tears. Level of Evidence: Level IV.

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        • Albrecht-Olsen P.M.
        • Kristensen G.
        • Törmälä P.
        Meniscus bucket-handle fixation with an absorbable Biofix tack.
        Knee Surg Sports Traumatol Arthrosc. 1993; 1: 104-106
      1. Investor’s Business Daily. 1997 (July 18)
        • Albrecht-Olsen P.M.
        • Kristensen G.
        • Burgaard P.
        The arrow versus horizontal suture in arthroscopic meniscus repair. A prospective randomized study with arthroscopic evaluation.
        Knee Surg Sports Traumatol Arthrosc. 1999; 7: 268-273
        • Hurel C.
        • Mertens F.
        • Verdonk R.
        Biofix resorbable Meniscus Arrow for meniscal ruptures.
        Knee Surg Sports Traumatol Arthrosc. 2000; 8: 46-52
        • Petsche T.S.
        • Selesnick H.
        • Rochman A.
        Arthroscopic meniscus repair with bioabsorbable arrows.
        Arthroscopy. 2002; 18: 246-253
        • Jones H.P.
        • Lemos M.J.
        • Wilk R.M.
        • Smiley P.M.
        • Gutierrez R.
        • Schipps A.A.
        Two year follow-up of meniscal repair using the bioabsorbable Arrow.
        Arthroscopy. 2002; 18: 64-69
        • Gill S.S.
        • Diduch D.R.
        Outcomes after meniscal repair using the Meniscus Arrow in knees undergoing concurrent ACL reconstruction.
        Arthroscopy. 2002; 18: 569-577
        • Albrecht-Olsen P.M.
        • Lind T.
        • Kristensen G.
        Failure strength of a new Meniscus Arrow repair technique.
        Arthroscopy. 1997; 13: 183-187
        • Boenisch U.W.
        • Faber K.J.
        • Ciarelli M.
        Pullout strength and stiffness of meniscal repair using absorbable arrows or Ti-Cron vertical and horizontal loop sutures.
        Am J Sports Med. 1999; 27: 626-631
        • Dervin G.F.
        • Downing K.J.
        • Keene
        • et al.
        Failure strengths of suture versus biodegradable arrow for meniscal repair.
        Arthroscopy. 1997; 13: 296-300
        • Song E.K.
        • Lee K.B.
        Biomechanical test comparing the load to failure of the biodegradable Meniscus Arrow versus meniscal suture.
        Arthroscopy. 1999; 15: 726-732
        • Seil R.
        • Rupp S.
        • Dienst M.
        • Mueller B.
        • Bankhoff H.
        • Kohn D.M.
        Chondral lesions after arthroscopic meniscal repair using Meniscus Arrows.
        Arthroscopy. 2000; 16 (available online at E17
        • Calder S.J.
        • Myers P.T.
        Broken Arrow.
        Arthroscopy. 1999; 15: 651-652
        • Menche D.S.
        • Phillips G.I.
        • Pitman M.I.
        • Sterner G.C.
        Inflammatory foreign-body reaction to an arthroscopic bioabsorbable meniscal arrow repair.
        Arthroscopy. 1999; 15: 770-772
        • Hutchinson M.R.
        • Ash S.A.
        Failure of a biodegradable meniscal arrow. A case report.
        Am J Sports Med. 1999; 27: 101-103
        • Ross G.
        • Grabill J.
        • McDevitt E.
        Chondral injury after meniscal repair with bioabsorbable arrows.
        Arthroscopy. 2000; 16: 754-756
        • Mehlman C.T.
        • Wall E.J.
        • Olsen G.S.
        Complications associated with the use of meniscal arrows in children. 1999 (Presented at the Annual Meeting of the Arthroscopy Association of North America, Miami, FL, March)
        • Anderson K.
        • Marx R.G.
        • Hannafin J.
        • Warren R.F.
        Chondral injury following meniscal repair with a biodegradable implant.
        Arthroscopy. 2000; 16: 749-753
        • Hechtman K.S.
        • Uribe J.W.
        Cystic hematoma formation following use of a biodegradable arrow for meniscal repair.
        Arthroscopy. 1999; 15: 207-210
        • Otte S.
        • Klinger H.M.
        • Beyer J.
        • Baums M.H.
        Complications after meniscal repair with bioabsorbable arrows.
        Knee Surg Sports Traumatol Arthrosc. 2002; 10: 250-253
        • Iannotti S.
        • Goldberg M.J.
        • Richmond J.C.
        Subcutaneous migration of bioabsorbable meniscal arrows.
        Am J Knee Surg. 2001; 14: 122-124
        • Menetrey J.
        • Seil R.
        • Rupp S.
        • Fritschy D.
        Chondral damage after meniscal repair with the use of a bioabsorbable implant.
        Am J Sports Med. 2002; 30: 896-899
        • Barber F.A.
        Accelerated rehabilitation for meniscus repairs.
        Arthroscopy. 1994; 10: 206-210
        • Barber F.A.
        • Click S.D.
        Meniscus repair rehabilitation with concurrent anterior cruciate reconstruction.
        Arthroscopy. 1997; 13: 433-437
        • Shelbourne K.D.
        • Nitz P.
        Accelerated rehabilitation after anterior cruciate ligament reconstruction.
        Am J Sports Med. 1990; 18: 292-299
        • Whitman T.L.
        • Diduch D.R.
        Transient posterior knee pain with the Meniscal Arrow.
        Arthroscopy. 1998; 14: 762-776
        • Cannon Jr, W.D.
        Arthroscopic meniscal repair.
        in: McGinty J.B. Caspari R.B. Jackson R.W. Operative arthroscopy. 2. Lippincott-Raven, Philadelphia1996: 299-315
        • Cannon Jr, W.D.
        • Morgan C.D.
        Meniscal repair. Part II. Arthroscopic repair techniques.
        J Bone Joint Surg Am. 1994; 76: 294-311
        • DeHaven K.E.
        • Black
        • Griffiths H.J.
        Open meniscus repair. Technique and two to nine year results.
        Am J Sports Med. 1989; 17: 788-795
        • DeHaven K.E.
        • Lohrer W.A.
        • Lovelock J.E.
        Long-term results of open meniscal repair.
        Am J Sports Med. 1995; 23: 524-530
        • Van Trommel M.F.
        • Simonian P.T.
        • Potter H.G.
        Differential regional healing rates with the outside-in technique for meniscal repair.
        Am J Sports Med. 1998; 26: 446-452
        • Villiger A.
        • Mayer M.
        Intermediate term results after arthroscopic meniscus suture [in German].
        Swiss Surg. 1997; 3: 149-153
        • Warren R.F.
        Meniscectomy and repair in the anterior cruciate ligament-deficient patient.
        Clin Orthop. 1990; 525: 55-63
        • Morgan C.D.
        • Wojtys E.M.
        • Casscells C.D.
        Arthroscopic meniscal repair evaluated by second-look arthroscopy.
        Am J Sports Med. 1991; 19: 632-638
        • Rubman M.H.
        • Noyes F.R.
        • Barber-Westin S.D.
        Arthroscopic repair of meniscal tears that extend into the avascular zone. A review of 198 single and complex tears.
        Am J Sports Med. 1998; 26: 87-95
        • Scott G.A.
        • Jolly B.L.
        • Henning C.E.
        Combined posterior incision and arthroscopic intra-articular repair of the meniscus. An examination of factors affecting healing.
        J Bone Joint Surg Am. 1986; 68: 847-861
        • Eggli S.
        • Wegmüller H.
        • Kosina J.
        Long-term results of arthroscopic meniscal repair. An analysis of isolated tears.
        Am J Sports Med. 1995; 23: 715-720
        • Hamberg P.
        • Gillquist J.
        • Lysholm J.
        Suture of new and old peripheral meniscus tears.
        J Bone Joint Surg Am. 1993; 65: 193-197
        • Hanks G.A.
        • Gause T.M.
        • Handal J.A.
        Meniscus repair in the anterior cruciate deficient knee.
        Am J Sports Med. 1990; 18: 606-613
        • Hanks G.A.
        • Gause T.M.
        • Sebastianelli W.J.
        Repair of peripheral meniscal tears.
        Arthroscopy. 1991; 7: 72-77
        • Sgaglione N.A.
        New generation meniscus fixator devices.
        Sports Med Arthrosc Rev. 2004; 12: 44-59