Purpose: To determine the healing rate of meniscal repair using the Meniscus Arrow (Bionx, Blue Bell, PA) in patients undergoing concurrent anterior cruciate ligament (ACL) reconstruction and to evaluate patient outcomes with the International Knee Documentation Committee (IKDC) form and a visual analog scale (VAS).
Type of study: Case series with outcomes analysis.
Methods: We retrospectively analyzed 38 consecutive patients with 39 meniscal tears in knees undergoing concurrent endoscopic ACL reconstruction whose menisci were repaired with the Meniscus Arrow system. All meniscal tears were deemed amenable to repair according to length, stability, morphology, and zone of tear. There were 31 medial and 8 lateral meniscal tears, with an average tear length of 2.1 cm. An average of 2.5 arrows were used to repair each tear. All 39 tears were located in the posterior horn of the meniscus or extending into the body of the meniscus from the posterior horn. Follow-up was assessed by clinical examination, the knee disorders subjective history, VAS, and the IKDC evaluation form. Reconstructed ACL laxity was assessed by KT-2000 arthrometry and clinical evaluation.
Results: At an average follow-up of 2.3 years (range, 18-39 months), 32 patients have been surveyed to date. The success rate was 90.6% (29 of 32 patients) with 3 patients going on to arthroscopic partial meniscectomy. KT-2000 arthrometry showed that sagittal knee laxity was less than 3 mm in all reconstructed knees. Clinical criteria for success in the rest of the repaired menisci included (1) the absence of locking, catching, or giving way; (2) no history of recurrent effusions; (3) no joint line tenderness; (4) a negative McMurray test; and (5) no subsequent surgical procedures on the repaired meniscus. Additionally, the VAS showed the ability of these patients to return to a high level of activity, including competitive sports, without symptoms suggestive of a meniscal tear. The IKDC showed normal or nearly normal function of all success knees.
Conclusions: The study shows that a high rate of meniscus healing can be achieved by the all-inside, bioabsorbable Meniscus Arrow system in conjunction with ACL reconstruction. Also, patients have excellent function of their knee and are able to return to a high level of activity. Our healing rates are comparable to those previously reported with the inside-out suture techniques without the need for an additional posterior incision that would increase operative time and risk to neurovascular structures.