Outcome of All-Inside Second Generation Meniscal Repair: Minimum 5-year Follow-up

Objectives: In the setting of injury, meniscal repair and preservation is the goal when possible. Current research on second generation all-inside repair systems is limited to a maximum of three year follow-up. The purpose of this study is to evaluate the long-term (> 5 years) clinical success of isolated meniscal repairs and those performed with concomitant ACL reconstruction using a second generation all-inside repair device. Methods: This a retrospective review of patients who underwent meniscal repair utilizing the all-inside FasT-Fix meniscal repair system (Smith & Nephew Arthroscopy, Andover, MA) between December 1999 and January 2007. Eighty-three meniscal repairs in 81 patients were identified and follow-up was obtained in 90%. Twenty-six patients (35%) had isolated meniscal repair. Clinical failure was defined as repeat surgical intervention involving resection or revision repair. Clinical outcomes (KOOS, IKDC, Marx Activity) were also assessed. Results: Minimum follow-up was 5 years (avg. 7 years). Twelve patients failed meniscal repair (16%). The average time to failure was 47 months (range, 15 - 94). There was no difference in average patient age, sex or number of sutures utilized between successful repairs and failures. There was no difference in failure rate between isolated repairs (11.5% CI: -0.76%-23.76%) and those performed with concurrent ACL reconstruction (18.3% CI: 7.47%-29.13%) and the average time to failure was similar between these two groups (48.1 months versus 46.6 months, p=0.243). Postoperative outcome scores were also similar (KOOS and IKDC). Conclusion: This first report of long term (> 5 yrs) follow-up of second generation all-inside meniscal repair demonstrates it is an effective method of primary meniscal repair for both isolated repairs and those performed with concurrent ACL reconstruction. After minimum five year follow-up, over 84% of patients continue to demonstrate successful repair. Treatment success is further supported by favorable results on patient based outcome measures.