2025 ISAKOS Biennial Congress ePoster
Fibrin Clot Augmentation of High-Risk Meniscal Repairs May Result in Clinical Healing in up to 90% of Cases
Peter T. Myers, AM, MBBS, FRACS, FAOrthA, Brisbane, QLD AUSTRALIA
Peter Samuel Edward Davies, MBChB, Dundee, Angus UNITED KINGDOM
Michael Goldberg, MBBS, FRACS, Vaucluse, NSW AUSTRALIA
Brisbane Orthopaedic and Sports Medicine Centre, Brisbane, Queensland, AUSTRALIA
The FDA has not cleared the following pharmaceuticals and/or medical device for the use described in this presentation. The following pharmaceuticals and/or medical device are being discussed for an off-label use: Portal SportsMed, Menipass meniscus repair needle; Portal SportsMed, Clotpass fibrin clot manufacturing device
Summary
For those meniscus tears which are considered to have a poorer chance of healing, fibrin clot augmentation of the repair, in selected cases, may result in a 90% rate of clinical healing.
ePosters will be available shortly before Congress
Abstract
Introduction
While meniscal repair is preferable to meniscectomy, some cases may be at higher risk of failure if repaired. Incorporating fibrin clot (FC) into the repair has been proposed to improve healing rates. The purpose of this study was to determine the failure rates, patient reported outcome measures (PROMs) and complications of FC augmented meniscal repair for cases considered to be at higher risk of failure.
Methods
A retrospective case series of all patients undergoing FC augmented repair of isolated meniscus tears between January 2016 and September 2021 was undertaken. All cases were thought be at higher risk of failure; they included chronic, radial, complex, horizontal cleavage, and tears not in the red – red zone. Patients were excluded if they had a concomitant anterior cruciate ligament (ACL) reconstruction or if the repair was done through an open incision. The primary outcome was clinical failure defined as further repair or debridement. Secondary outcomes were PROMs and surgical complications. PROMs collected were Lysholm score, Knee injury and Osteoarthritis Outcome Score, Oxford Knee Score and the Tegner score.
Results
51 inside-out meniscal repairs using FC were performed in 50 patients (62% male). The mean age was 34 years (range 14-70). The median time from injury to repair was 122 days (range 4-1565). The medial meniscus was repaired in 63% of cases. Tear types included radial (31%) and complex (39%) and 71% of cases included repair of the white-white zone. 16% of cases were revision meniscal repairs. FC was used in 43% of isolated meniscal repairs performed during the study period. All patients were followed up to a median of 46 months (range 22-87 months). PROMs at a median of 30 months post-operatively showed statistically significant improvements. Five patients (10%) underwent further surgery for failure after median 21 months indicating a clinical failure rate of 10%. Two patients (4%) reported sensory disturbance around their skin wounds, no other complications were reported. 13% of medial meniscal repairs failed, whereas only 5% of lateral meniscal repairs failed (p=0.4).
Conclusions
FC augmented meniscal repair performed for tears considered to be at higher risk of failure may result in acceptably low rates of clinical failure.