Effectiveness of Bioabsorbable Arrows Compared With Inside-Out Suturing for Vertical,Reparable Meniscal Lesions

Abstract

Background: Techniques for repairing the meniscus include both open and arthroscopic techniques using sutures and bioabsorbable implants. The purpose of this study was to compare the effectiveness of inside-out suturing and bioabsorbable arrows for repair of vertical meniscal lesions.

Study Design: Randomized controlled clinical trial; Level of evidence, 1.

Methods: One hundred consecutive patients were randomly assigned to arrows (n = 51) or sutures (n = 49). Sixty-five percent of patients (31 sutures, 34 arrows) underwent a concomitant anterior cruciate ligament reconstruction. A blinded research associate conducted assessments at 6 weeks and 3, 6, 12, and 24 months postoperatively. The primary outcome was retear rate. Secondary outcomes included the Western Ontario Meniscal Evaluation Tool, Anterior Cruciate Ligament Quality of Life Outcome Measure, and side-to-side comparisons of flexion and extension.

Results: At baseline, groups were similar in age, gender, time from injury to surgery, and length and location of tear. Mean follow-up was 28.0 ± 8.4 months. There were 22 failed meniscal repairs (11 in each group), which did not represent a significant difference in the rate of failure between groups (P = .92). The mean quality of life scores and side-to-side differences in extension and flexion measurements were not significantly different between groups. Two patients from the arrow group crossed over into the suture group at the time of surgery because of technical difficulties with the device, and in 3 instances, a single suture was needed to keep the tear reduced while arrows were introduced. Two patients required reoperation for removal of a prominent, subcutaneous arrow, and 1 patient in the suture group suffered a transient peroneal nerve palsy during revision suturing.

Conclusion: At intermediate follow-up, there were no statistically significant differences in measured outcomes between meniscal suturing and arrows. Longer term follow-up is necessary to identify differences between these 2 treatments, particularly to estimate the incidence of articular surface damage in patients whose meniscal tear was repaired using arrows.

Keywords

meniscal lesion meniscal repair arrow inside-out suturing

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References

Albrecht-Olsen P.

Kristensen G.

Burgaard P.

Joergensen U.

Toerholm C.

The arrow versus horizontal suture in arthroscopic meniscus repair: a prospective randomized study with arthroscopic evaluation. [see comment]. Knee Surg Sports Traumatol Arthrosc. 1999;7:268-273.

Albrecht-Olsen P.

Lind T.

Kristensen G.

Falkenberg B.

Failure strength of a new meniscus arrow repair technique: biomechanical comparison with horizontal suture. Arthroscopy. 1997;13:183-187.

Arnoczky SP

Lavagnino M.

Tensile fixation strengths of absorbable meniscal repair devices as a function of hydrolysis time: an in vitro experimental study. Am J Sports Med.2001;29:118-123.

Becker R.

Wirz D.

Wolf C.

Gopfert B.

Nebelung W.

Friederich N.

Measurement of meniscofemoral contact pressure after repair of bucket-handle tears with biodegradable implants. Arch Orthop Trauma Surg.2005;125:254-260.

Bourne RB

Finlay JB

Papadopoulos P.

Andreae P.

The effect of medial meniscectomy on strain distribution in the proximal part of the tibia. J Bone Joint Surg Am. 1984 ;66:1431-1437.

Brosseau L.

Tousignant M.

Budd J.

, et al. Intratester and intertester reliability and criterion validity of the parallelogram and universal goniometers for active knee flexion in healthy subjects [review]. Physiother Res Int. 1997;2:150-166.

Cox JS

Nye CE

Schaefer WW

Woodstein IJ

The degenerative effects of partial and total resection of the medial meniscus in dogs' knees. Clin Orthop Relat Res.1975 ;109:178-183.

DeHaven KE

Black KP

Griffiths HJ

Open meniscus repair: technique and two to nine year results [review] . Am J Sports Med.1989;17:788-795.

Dervin GF

Downing KJ

Keene GC

McBride DG

Failure strengths of suture versus biodegradable arrow for meniscal repair: an in vitro study. Arthroscopy. 1997 ;13:296-300.

10.

Fairbank TJ

Knee joint changes after meniscectomy. J Bone Joint Surg Br.1948;30:664-670.

11.

Fukubayashi T.

Kurosawa H.

The contact area and pressure distribution pattern of the knee: a study of normal and osteoarthrotic knee joints. Acta Orthop Scand. 1980;51:871-879.

12.

Gliatis J.

Kouzelis A.

Panagopoulos A.

Lambiris E.

Chondral injury due to migration of a Mitek RapidLoc meniscal repair implant after successful meniscal repair: a case report. Knee Surg Sports Traumatol Arthrosc. 2005;13:280-282.

13.

Hurel C.

Mertens F.

Verdonk R.

Biofix resorbable meniscus arrow for meniscal ruptures: results of a 1-year follow-up. Knee Surg Sports Traumatol Arthrosc. 2000;8:46-52.

14.

Kirkley A.

Griffin S.

Huffman H.

Whelan D.

The development and evaluation of a disease-specific measurement tool for patients with meniscal pathology: the Western Ontario Meniscal Evaluation Tool. Paper presented at: Canadian Orthopaedic Association meeting; June 2005; Montreal, Canada.

15.

Kristensen G.

Albrecht-Olsen PM

Burgaard P.

Biofix meniscal tacks versus inside out suturing technique in the treatment of bucket-handle lesions: a prospective randomized study. Acta Orthop Scand . 1994;65:17.

16.

LaPrade RF

Wills NJ

Kissing cartilage lesions of the knee caused by a bioabsorbable meniscal repair device: a case report. Am J Sports Med.2004 ;32:1751-1754.

17.

Lynch MA

Henning CE

Glick KR Jr.

Knee joint surface changes: long-term follow-up meniscus tear treatment in stable anterior cruciate ligament reconstructions. Clin Orthop Relat Res.1983;172: 148-153.

18.

McGinity JB

Geuss LF

Marvin RA

Partial or total meniscectomy: a comparative analysis. J Bone Joint Surg Am. 1977;59:763-766.

19.

Mohtadi N.

Development and validation of the quality of life outcome measure (questionnaire) for chronic anterior cruciate ligament deficiency. Am J Sports Med.1998;26:350-359.

20.

Northmore-Ball MD

Dandy DJ

Long-term results of arthroscopic partial meniscectomy. Clin Orthop Relat Res.1982;167:34-42.

21.

Oliverson TJ

Lintner DM

Biofix arrow appearing as a subcutaneous foreign body. Arthroscopy. 2000;16:652-655.

22.

Renstrom P.

Johnson RJ

Anatomy and biomechanics of the menisci [review] . Clin Sports Med.1990;9:523-538.

23.

Rodeo SA

Warren RF

Meniscal repair using the outside-to-inside technique [review]. Clin Sports Med.1996;15:469-481.

24.

Ross G.

Grabill J.

McDevitt E.

Chondral injury after meniscal repair with bioabsorbable arrows. Arthroscopy. 2000;16:754-756.

25.

Schulte KR

Fu FH

Meniscal repair using the inside-to-outside technique. Clin Sports Med.1996;15:455-467.

26.

Seil R.

Rupp S.

Dienst M.

Mueller B.

Bonkhoff H.

Kohn DM

Chondral lesions after arthroscopic meniscus repair using meniscus arrows . Arthroscopy. 2000;16:E17.

27.

Spindler KP

McCarty EC

Warren TA

Devin C.

Connor JT

Prospective comparison of arthroscopic medial meniscal repair technique: inside-out suture versus entirely arthroscopic arrows. Am J Sports Med.2003; 31:929-934.