Summary

Meniscal allograft transplantation fixed with the Fast-Fix 360 and sutures passed through bone tunnels yielded good functional results at the short-term follow-up. Furthermore, a low complication rate was observed.

Abstract

Introduction

Controversy regarding the best fixation method for attaching the meniscal allograft transplantation (MAT) to the tibial plateau still exist.
On the other hand, the all-inside suture technique is the gold standard for fixing the meniscal allograft to the meniscal rim.
The aim of this study was to retrospectively analyze the functional outcomes and the complication rate of MAT fixed with the Fast-Fix 360.
1st hypothesis: MAT fixed with the Fast-Fix 360 would yield good functional.
2nd hypothesis: the use of the Fast-Fix 360 system would result in a low complication rate.

Methods

A retrospective study of 24 consecutive MAT was performed

Surgical technique
Posteriorly, two 5-mm bone tunnels were drilled at the anatomic sites of meniscal insertion.
Krackow mattress suture was placed at each meniscal horn. The posterior-horn suture was used to pull the meniscal allograft to its proper place. The allograft was then fixed to the meniscal rim, with the combination of an all-inside meniscal repair implant (Fast-Fix 360, Smith & Nephew, Andover, Massachusetts) in the posterior horn and the meniscal body and an outside-in vertical mattress sutures in the anterior horn. Finally, the sutures placed in the anterior and posterior horns were tied together over the anteromedial tibial cortex.

Functional outcomes
Lysholm, KOOS and Tegner score. A 10-point visual analog scale (VAS) was also used.

Statistical analysis
In all cases, a 95% confidence interval was calculated. Likewise, preoperative and postoperative values were compared with paired Student’s t-test. The level of statistical significance was set to be 0.05.

Results

At a mean of 2 years postoperatively, all 24 patients were available for follow-up. The series included 15 men (62.5%) and 9 women (37.5%), with a mean age of 36.3 years (range, 24-49 years). All transplantations were performed to replace the lateral meniscus.
A total of 142 Fast-Fix 360® devices were used, and the median count per patient was 4.9 (range, 4-7). One hundred three (72.5%) sutures were vertical, and 39 (27.5%) were horizontal. A median of 2.3 (range 2-3) outside-in vertical sutures per patient were used.
Additional procedures were performed in 9 patients (37.5%)

Functional results
Lysholm: 53.3 ± 9.5 preoperatively to 89.2 ± 6 (P < .001)
Tegner: 6.6 ± 3.1 preoperatively to 3 ± 1.8 (P < .001)
KOOS: 48.11 ± 2.3 preoperatively to 87.68 ± 4.6 (P < .001)
VAS: improved by 5.2 points. It dropped from a mean of 7.1 ± 1.5 to 1.9 ± 1.1 at the follow-up (P < .001).

Complications
In 3 patients (12.5%), a second surgery was necessary because of suture failure. Arthroscopic refixation was required.
The complications included 1 (4.2%) case of arthrofibrosis, which required arthroscopic arthrolysis, and the MAT looked stable in this patient.

Conclusion

Meniscal allograft transplantation fixed with the Fast-Fix 360 yielded good functional results at the short-term follow-up. Furthermore, a low complication rate was observed.