Summary

This meta-analysis demonstrates that meniscal repair utilising FAST-FIX all-inside meniscal repair devices are associated with high success rates, low revision rates and excellent patient outcomes.

Abstract

Background

Meniscal tears are a common knee injury seen by specialists, primarily treated with meniscectomy. However, with growing knowledge of the long-term consequences associated with meniscectomy, repair of meniscal tears is becoming increasingly important. Repair of meniscal tears with all-inside techniques has several advantages over traditional inside-out meniscal repair.

Purpose

To establish the success rate, revision rate and patient-reported outcome measures (PROMs) following repair of a meniscus tear using FAST-FIX™ all-inside meniscal repair devices (Smith & Nephew).

Study design and methods: A systematic literature review of Embase and PubMed was performed in June 2022 to identify English-language clinical studies that detailed either meniscal repair success rates, revision rates or PROMs when using FAST-FIX. Meta-analysis was used to determine success rate of repair, revision surgery rate and PROMs across the included studies for all repairs, isolated repairs and repairs with concomitant anterior cruciate ligament reconstruction (ACLR).

Results

A total of 38 studies met the inclusion criteria. Proportional meta-analysis identified a success rate of 88% (95% confidence interval (CI): 86-90; 38 studies; n=2114) at a weighted mean follow-up time of 34.4 months. Success rate of isolated repairs was 92% (95% CI: 89-94; 17 studies; n=365) and with concomitant ACLR was 89% (95% CI: 87-91; 23 studies; n=941) at weighted mean follow-up of 32.2 and 37.2 months, respectively. Re-operation rate on the same meniscal injury was 10% (95% CI: 7-14; 26 studies; n=1484) at a weighted mean follow-up of 39.7 months. Re-operation rate for isolated repairs was 6% (95% CI: 4-9; 14 studies; n=273) and with concomitant ACLR was 11% (95% CI: 9-14; 13 studies; n=562). Mean post-operative International Knee Documentation Committee (IKDC) score was 86.3 (95% CI: 83.9-88.8; 9 studies; n=439), Lysholm was 89.4 (95% CI: 86.8-92.1; 17 studies; n=665) and Tegner activity score was 6.2 (95% CI: 5.8-6.6; 11 studies; n=355) at weighted mean follow-up of 37.4, 28.3 and 54.5 months, respectively. When PROMs were analysed according to isolated repair or with concomitant ACLR, IKDC for isolated repair was 84.6 (95% CI: 78.3-90.9; 2 studies; n=46; weighted mean follow-up, 58.6 months), and with ACLR was 84.8 (95% CI: 81.7-88.0; 5 studies; n=186; weighted mean follow-up, 41.1 months); Lysholm for isolated repair was 85.6 (95% CI: 73.9-97.4; 5 studies; n=151; weighted mean follow-up, 29.6 months) and 90.8 (95% CI: 89.1-92.5; 11 studies; n=345; weighted mean follow-up, 26.7 months) for those with concomitant ACLR; and Tegner for isolated repair was 6.2 (95% CI: 5.6-6.7; 7 studies; n=136; weighted mean follow-up, 46.5 months) and 6.1 (95% CI: 5.5-6.6; 6 studies; n=158; weighted mean follow-up, 72.2 months) with ACLR.

Conclusions

Meniscal repairs using FAST-FIX all-inside device has a low failure rate and is associated with patients reporting high PROMs. Post-operative outcomes are broadly similar for isolated meniscal repair and with concomitant ACLR.