title: Outcome of All-Inside Second-Generation Meniscal Repair: Minimum Five-Year Follow-up.
abstract: BACKGROUND
  Meniscal repair and preservation are the goal, when possible, of the treatment of meniscal injury. Current research on second-generation all-inside repair systems has been limited to a maximum of three years of follow-up. The purpose of this study was to evaluate the mid-term clinical success (at more than five years) of meniscal repair performed with a second-generation all-inside repair device, both as an isolated procedure and with a concomitant anterior cruciate ligament (ACL) reconstruction.
  
  
  METHODS
  This is a retrospective review of patients who underwent meniscal repair with use of the all-inside FAST-FIX Meniscal Repair System (Smith & Nephew Arthroscopy, Andover, Massachusetts) from December 1999 to January 2007. Eighty-three meniscal repairs (in eighty-one patients) were identified, and follow-up data were obtained for seventy-five (90%). Twenty-six (35%) of the meniscal repairs were performed as isolated procedures. Clinical failure was defined as repeat surgical intervention involving resection or revision repair. Clinical outcomes were also assessed with the Knee injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) score, and the Marx activity score.
  
  
  RESULTS
  The minimum duration of follow-up was five years (average, seven years). Twelve patients (16%) had failure of the meniscal repair, at an average of forty-seven months (range, fifteen to ninety-five months). The data did not offer enough statistical evidence, at alpha = 0.05, to establish a difference in average patient age, patient sex, or number of sutures utilized between successful repairs and failures. There was no difference in the failure rate between isolated repairs (12%; 95% confidence interval [CI]: -0.76% to 23.76%) and those performed with concurrent ACL reconstruction (18%; 95% CI: 7.47% to 29.13%), and the average time to failure was similar between these two groups (48.1 months versus 46.6 months, p = 0.939). Postoperative KOOS and IKDC outcome scores were also similar between the groups.
  
  
  CONCLUSIONS
  This report of mid-term follow-up results of primary second-generation all-inside meniscal repair demonstrates its effectiveness both as an isolated procedure and when it is performed with concurrent ACL reconstruction. After a minimum of five years of follow-up, 84% of the patients continued to demonstrate successful repair. Treatment success was further supported by favorable results on patient-based outcome measures.
  
  
  METHODS
  Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine, One Barnes-Jewish Plaza, Suite 11300, West Pavilion, Campus Box 8233, St. Louis, MO 63110. E-mail address for L. Bogunovic: bogunovicl@wudosis.wustl.edu. E-mail address for L.M. Kruse: krusel@wudosis.wustl.edu. E-mail address for A.K. Haas: haasa@wudosis.wustl.edu. E-mail address for L.J. Huston: Laura.huston@vanderbilt.edu. E-mail address for R.W. Wright: wright@wudosis.wustl.edu.
authors.forename: Ljiljana
authors.initials: L
authors.lastname: Bogunovic
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine, One Barnes-Jewish Plaza, Suite 11300, West Pavilion, Campus Box 8233, St. Louis, MO 63110. E-mail address for L. Bogunovic: bogunovicl@wudosis.wustl.edu. E-mail address for L.M. Kruse: krusel@wudosis.wustl.edu. E-mail address for A.K. Haas: haasa@wudosis.wustl.edu. E-mail address for L.J. Huston: Laura.huston@vanderbilt.edu. E-mail address for R.W. Wright: wright@wudosis.wustl.edu.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Kruse
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine, One Barnes-Jewish Plaza, Suite 11300, West Pavilion, Campus Box 8233, St. Louis, MO 63110. E-mail address for L. Bogunovic: bogunovicl@wudosis.wustl.edu. E-mail address for L.M. Kruse: krusel@wudosis.wustl.edu. E-mail address for A.K. Haas: haasa@wudosis.wustl.edu. E-mail address for L.J. Huston: Laura.huston@vanderbilt.edu. E-mail address for R.W. Wright: wright@wudosis.wustl.edu.
authors.forename: Amanda K
authors.initials: AK
authors.lastname: Haas
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine, One Barnes-Jewish Plaza, Suite 11300, West Pavilion, Campus Box 8233, St. Louis, MO 63110. E-mail address for L. Bogunovic: bogunovicl@wudosis.wustl.edu. E-mail address for L.M. Kruse: krusel@wudosis.wustl.edu. E-mail address for A.K. Haas: haasa@wudosis.wustl.edu. E-mail address for L.J. Huston: Laura.huston@vanderbilt.edu. E-mail address for R.W. Wright: wright@wudosis.wustl.edu.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Huston
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine, One Barnes-Jewish Plaza, Suite 11300, West Pavilion, Campus Box 8233, St. Louis, MO 63110. E-mail address for L. Bogunovic: bogunovicl@wudosis.wustl.edu. E-mail address for L.M. Kruse: krusel@wudosis.wustl.edu. E-mail address for A.K. Haas: haasa@wudosis.wustl.edu. E-mail address for L.J. Huston: Laura.huston@vanderbilt.edu. E-mail address for R.W. Wright: wright@wudosis.wustl.edu.
authors.forename: Rick W
authors.initials: RW
authors.lastname: Wright
mesh_terms: D000293:Adolescent; D000328:Adult; D059549:Anterior Cruciate Ligament Reconstruction; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007718:Knee Injuries / Q000601:surgery*; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D000072600:Meniscus / Q000293:injuries* / Q000601:surgery*; D008875:Middle Aged; D019637:Orthopedic Procedures; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
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