The extent of laceration of circumferential fibers with suture repair of the knee meniscus. Winner of the AGA DonJoy award 2006.

Department of Orthopaedic Surgery, Otto-von-Guericke University Magdeburg, Leipziger Strasse 44, 39120, Magdeburg, Germany.
Archives of Orthopaedic and Trauma Surgery (Impact Factor: 1.6). 05/2008; 128(5):525-30. DOI: 10.1007/s00402-007-0533-2
Source: PubMed


Cannulas used with suture based meniscal repair techniques can potentially injure the load transmitting fibers of the meniscus. The subject of this study was to quantify this effect in a porcine in vitro model.
From fresh frozen medial porcine menisci tissue specimens were harvested following the course of the peripheral circumferential fibers bundles. In the first part of the study the tissue samples were perforated with the cannulas of either a Fast Fix or a Rapidloc device or with an 18-gauge needle. The specimens were then visually inspected for fiber damage using low power microscopy and the mean size of the laceration was measured. Finally, the extent of the tissue laceration was indirectly determined using non-contact strain measurements of the samples before and after puncture.
When advanced with the cutting edge perpendicular to the fibers, the cannulas consistently cut the fibers while those were rather separated with the opposite orientation. It could be shown that specimens with a mean width of 8.1 mm lost 25% of the load transmitting cross section when being perforated two times with a Fast Fix device (P < 0.001). This effect is negated when the cannula was oriented in line with the fibers.
Cannulas used for suture based meniscal repair can cause a substantial laceration of the meniscal tissue. The effect strongly depends on the orientation of the cutting edge of the cannula relative to the course of the fibers and can thus potentially be avoided by an appropriate handling and design.

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Available from: Sebastian Kopf, May 22, 2015
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    ABSTRACT: Die US-amerikanische „National Library of Medicine“ wurde systematisch nach zwischen August 2000 und Januar 2009 veröffentlichten Studien mit den Suchbegriffen „meniscal repair“ und „meniscus arrow“ durchsucht. Die Beurteilung der Autoren zum Einsatz von Meniskuspfeilen wurde den Kategorien „positiv“, „differenziert“ und „unbefriedigend“ zugeordnet. Es wurden 15 Originalarbeiten gefunden, die über klinische Ergebnisse der Meniskusrefixation mit Pfeilen berichteten. Für den Zeitraum 2002–2004 wurden 6 Studien identifiziert, die alle den Einsatz von Meniskuspfeilen als gleichwertig zur Naht bewerteten. Unter den 9 Arbeiten im Zeitraum 2005–2009 befanden sich 5 mit kritischer, 3 mit differenzierter und 1 mit positiver Bewertung. Die Heilungsraten der Arbeiten vom Zeitraum 2002–2004 von 90% (87–97%) sanken im Zeitraum 2005–2009 auf 74% (59–95%). Das Follow-up der Studien betrug im Zeitraum 2002–2004 im Durchschnitt 34 Monate, in den Jahren 2005–2009 im Durchschnitt 47 Monate. Die Ergebnisse der Literaturanalyse geben berechtigten Anlass für die Empfehlung, für eine Naht gut zugängliche Meniskusabschnitte nicht mit Meniskuspfeilen, sondern klassisch entweder mit Outside-in- oder Inside-out-Naht zu fixieren. In the period between August 2000 and January 2009 articles were retrieved from the American “National Library of Medicine” in the framework of a systematic search for the key words “meniscal repair” and “meniscus arrow”. The authors’ opinions on the use of meniscus arrows were categorised as “positive”, “differentiated” and “unsatisfactory”. In all, 15 publications were found that reported clinical results of meniscal repair using arrows. Six studies were published between 2002 and 2004 which considered arrows and sutures to be equivalent. Of the nine studies published between 2005 and 2009 five studies fell into the category “unsatisfactory”, three studies into “differentiated” and one study into “positive”. The clinical success rate of 90% (87–97%) found in the studies published between 2002 and 2004 decreased to 74% (59–95%) as published between 2005 and 2009. The average follow-up in the studies published between 2002 and 2004 was 34 months compared to 47 months in the studies published between 2005 and 2009. The results of this literature review indicate that, if meniscal parts are accessible for suture, the conventional outside-in or inside-out suture techniques should be applied instead of arrows.
    Trauma und Berufskrankheit 08/2009; 11:130-135. DOI:10.1007/s10039-009-1481-6
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