title: New Complication Associated With All-Inside Meniscal Repair Device: Ultrasound-Aided Diagnosis and Operative Localization of Foreign Body Reaction.
abstract: BACKGROUND
  The importance of meniscal preservation has become widely accepted, and meniscal repair techniques have evolved over recent years. With new techniques come new complications, which are critical to recognize.
  
  
  OBJECTIVE
  To describe a new complication of foreign body reaction from a nonabsorbable suture anchor associated with improper placement of the all-inside meniscal device.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  This study was a retrospective review of 3 patients who developed pain associated with a foreign body reaction from a misplaced all-inside meniscal device.
  
  
  RESULTS
  All patients had a delayed diagnosis (6 months to 8 years) and negative magnetic resonance imaging (MRI). Diagnostic ultrasound identified the misplaced suture with foreign body reaction and was used to guide a diagnostic injection of local anesthetic prior to surgical intervention. Intraoperative ultrasound guidance was utilized to precisely localize and excise the suture material and associated reactive tissue.
  
  
  CONCLUSIONS
  Foreign body reaction from a misplaced all-inside meniscal device is a previously unreported complication. Diagnosis is challenging as MRI and arthroscopy can be unrevealing. Diagnostic ultrasound was able to identify the foreign body reaction, confirm the diagnosis by facilitating diagnostic local anesthetic injection, and guide surgical excision. Sonographic evaluation should be considered in patients presenting with ongoing knee pain after all-inside meniscus repair.
authors.affiliation: Department of Orthopedic Surgery, Indiana University Health, Fishers, Indiana, USA.
authors.forename: Lucian C
authors.initials: LC
authors.lastname: Warth
authors.affiliation: Department of Orthopedics and Rehabilitation, University of Iowa Sports Medicine, Iowa City, Iowa, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Bollier
authors.affiliation: Department of Orthopedic Surgery, Essentia Health, Duluth, Minnesota, USA.
authors.forename: Douglas F
authors.initials: DF
authors.lastname: Hoffman
authors.affiliation: Department of Orthopedic Surgery, Essentia Health, Duluth, Minnesota, USA.
authors.forename: Justin S
authors.initials: JS
authors.lastname: Cummins
authors.affiliation: Department of Orthopedics and Rehabilitation, University of Iowa Sports Medicine, Iowa City, Iowa, USA.; Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
authors.forename: Mederic M
authors.initials: MM
authors.lastname: Hall
keywords: diagnostic ultrasound; knee arthroscopy; meniscus repair; postoperative complications