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Document Title: Lee-AJSM-Aug05.shtml
Article Title: Deteriorating Outcomes After Meniscal Repair Using the Meniscus Arrow in Knees Undergoing Concurrent Anterior Cruciate Ligament Reconstruction -- Increased Failure Rate With Long-term Follow-up
Authors: Gregory P. Lee, MD and David R. Diduch, MD
Publication: American Journal of Sports Medicine, Baltimore, Maryland
Date: August 2005
Volume 33, pages 1138-1141
Keywords: meniscal repair, meniscus, barbs, arrows, long-term outcomes, need for careful suturing.
(Reference-denoting numbers appear in the same font and point size as the document text. As with all Knee Library documents, this article is provided in full-text form, complete with all figures and tables.)
Comments: The authors, pursuing meniscal repair in conjunction with ACL reconstruction, found that using the Bionx Arrow brings disappointing results in the medium term, a finding which also applies in the case of meniscal repair without concurrent ligament reconstruction. (Note: The mean 6.6 year follow-up of this study makes it the longest to date, but when the yardstick is patient lifespan, then "long-term" arguably should be at least a decade.) Meniscal repair is best done with a careful inside-out (or vertical-mattress-style) suturing technique, a method pioneered by Dr. Frank Noyes and discussed in several articles involving numerous authors, for example Noyes-AJSM-Jul02.shtml, Rubman-AJSM-Jan98.shtml, McLaughlin-TO-Mar93.shtml.
ABSTRACT
Background: An increased awareness of the degenerative changes that occur in the knee after meniscectomy has led to efforts to salvage the injured meniscus. Numerous devices have been developed in an effort to provide the dual benefits of a durable meniscal repair and minimal invasiveness.
Hypothesis: The Meniscus Arrow is comparable to conventional inside-out suture repair in accomplishing long-term healing of meniscal tears.
Study Design: Case series; Level of evidence, 4.
Methods: This study is an extended follow-up of an original series of 32 patients with outcomes analysis. All patients underwent meniscal repair with exclusive use of the arrow. All repairs were performed in the context of a concomitant anterior cruciate ligament reconstruction. Follow-up assessment included physical examination, arthrometry, the International Knee Documentation Committee instrument, and the Knee Disorders Subjective History visual analog scale. Intermediate follow-up at a mean of 2.3 years yielded a success rate of 90.6%. The mean follow-up in the present study has been extended to 6.6 years.
Results: The extended follow-up analysis revealed a substantial attrition in the success rate of this series of patients undergoing meniscal repair with the arrow. A 90.6% success rate at a mean follow-up of 2.3 years deteriorated to 71.4% at 6.6 years.
Conclusion: This study provides the longest follow-up in the literature of any of the all-inside meniscal repair implants. The Meniscus Arrow demonstrated long-term meniscal healing rates inferior to those found in the literature for inside-out suture repair techniques.
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