2021 ISAKOS Biennial Congress Paper
Use Of A Continuous All-Inside Meniscal Repair Device Produces Excellent Outcomes For Meniscal Repair In Patients With And Without Concurrent Anterior Cruciate Ligament Reconstruction
Sarah Shaw, MBChB, BSc , Manchester UNITED KINGDOM
Neil Jain, BM, MRCS(Ed), FRCS(Tr&Orth), Manchester UNITED KINGDOM
Northern Care Alliance, Manchester, UNITED KINGDOM
FDA Status Cleared
We describe the first clinical results from the use of a continuous All-Inside meniscal repair device and show this to produce excellent early to mid-tern results with high patient satisfaction and low meniscal re-tear rates.
Meniscal tears remain common within sport and with the philosophy to 'save the meniscus', meniscal repair has become more common and is clearly preferred to meniscectomy. Many meniscal repair techniques exist. An Inside-Out technique was previously considered the gold standard although All-Inside techniques have gained popularity recently. Previous studies describe clinical outcomes following individual All-Inside sutures and while a laboratory study shows potential biomechanical advantages of a continuous All-Inside suture technique no studies exist that describe clinical results. Therefore, to our knowledge we present the first series of clinical results and outcomes following meniscal repair with a continuous All-Inside device.
Over a 4-year period, 35 patients underwent arthroscopic meniscal repair using a continuous All-Inside meniscal device (CONMED Linvatec Sequent). This comprised of 28 males and 7 females. The mean age was 28 years (range 16 to 48 years) with a mean time from injury to surgery of 7 months (range 1 to 36 months). Each patient was followed up to a mean of 36 months (range 18 to 72 months). Patients were assessed for Tegner Score, IKDC Score, whether they had returned to sport, whether they had returned to the same level of sport and whether they had required further surgery on the knee, i.e. a further meniscal operation due to a failed repair. Concurrent surgery in the form of Anterior Cruciate Ligament Reconstruction (ACL-R) was also noted. The meniscus repaired (Medial or Lateral or Both) was recorded. All patients underwent standard physiotherapy protocol which was guided by a 'safe zone' range of motion determined by the intra-operative findings. All patients were permitted to weight bear from day 1 post-operatively.
The overall mean post-op Tegner score was 93.5 (range 69 to 100) and IKDC Score was 93.5 (range 74 to 100). A perfect (100 out of 100) Tegner score was observed in 47% of patients and a perfect (100 out of 100) IKDC score was observed in 41% of patients. Four patients (11.4%) required further surgery and were found to have a failed repair. One of these patients had a revision repair and remains asymptomatic. The other 3 required partial meniscectomy. This suggests an 88.6% survival rate or successful repair rate. When reviewing sub-groups of patients with concurrent ACL-R the highest mean post op Tegner and IKDC scores were observed in the group that underwent Medial Meniscal Repair with ACL-R (98 and 98.2). The lowest scores were observed in the Medial Meniscal Repair Group without ACL-R (83.2 and 87.8). Almost all patients (94.3%) were able to return to some form of sport with 88.2% returning to the same level of sport.
A continuous All-Inside Suture technique for meniscal repair has been suggested to have biomechanical benefit over an individual All-Inside technique. We have demonstrated excellent early to mid-term clinical results from the use of such a device and therefore our findings would support this suggested benefit. In particular we observed high rates of return to play and a low re-tear rate. We would advocate its use.