Purpose
(1) To investigate the pattern and diameter of the iatrogenic defect that meniscal
repair devices impose on meniscal tissue and (2) to determine whether repair-induced
defect patterns or diameters differ across devices.
Methods
Sixty-one fresh frozen human cadaveric menisci were used (n = 9; eliminated). All-inside
devices (n = 9) included ULTRA FAST-FIX, FAST-FIX 360, Depuy Mitek 0° and 12° TRUESPAN,
ConMed Sequent, Zimmer Biomet JuggerStitch, Stryker IvyAIR, Arthrex FiberStitch and
Meniscal Cinch II. Inside-out needles (n = 4) included ConMed HiFi, Depuy Mitek ORTHOCORD,
Arthrex-2-0 FiberWire, and Stryker SharpShooter. Following India Ink staining, implant
devices were inserted into cadaveric menisci. Samples were fixed in formalin solution
and imaged with a high-resolution camera. Defects were classified by qualitative evaluation.
Defect and needle diameter were quantified with software assistance. Statistical analysis
was performed using analysis of variance testing.
Results
We analyzed 644 iatrogenic defects with mean defect diameter of 1.96 mm (standard
deviation 0.86). For all-inside devices, defect patterns (n = 436) were 15.6% linear,
38.1% semilunar, 46.3% stellate, while inside-out devices (n = 208) were 95.7% stellate,
4.3% linear, and 0.0% semilunar. All-inside devices had mean defect diameter of 2.46
mm, while inside-out meniscus needles had mean 0.90 mm defect diameter (P < .001). FasT-FIX 360, ULTRA-FAST-FIX, and Arthrex Meniscal Cinch II induced smaller
diameter defects than other all-inside devices (F = 20.2, P < .05). Strong positive correlation was found comparing outer needle diameter and
mean defect diameters across all devices (R2 = 0.9447).
Conclusions
Needles utilized in meniscal implant systems produce the following basic defect patterns:
stellate (62.3%), semilunar (25.8%), and linear (11.9%). A strong positive correlation
was found between mean defect size and outer needle diameter across all devices. Inside-out
double-armed flexible needles produced significantly smaller defects than all-inside
devices. Of the all-inside devices, ULTRA FAST-FIX, FAST-FIX 360, and Arthrex Meniscal
Cinch II produced smaller defects on average.
Clinical Relevance
While the true clinical impact of these findings cannot be drawn from the present
study, this investigation provides necessary context to better understand reported
similarities and differences in healing rates and outcomes between inside-out and
all-inside repair techniques.
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Article info
Publication history
Published online: August 30, 2022
Accepted:
May 13,
2022
Received:
December 14,
2021
Footnotes
The authors report the following potential conflicts of interest or sources of funding: D.C.F. reports personal fees from DePuy Mitek, Smith & Nephew, Vericel, Ceterix, ConMed, Histogenics, and Zimmer, outside the submitted work. ICMJE author disclosure forms are available for this article online, as supplementary material.
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© 2022 by the Arthroscopy Association of North America
