2015 ISAKOS Biennial Congress ePoster #1603
Cyst Formation After Using All-Inside Meniscal Repair Device Fast-Fix
Shozaburo Terai, MD, PhD, Straubing, Bavaria GERMANY
Yusuke Hashimoto, MD, PhD, Osaka JAPAN
Shinya Yamasaki, MD, PhD, Osaka JAPAN
Junsei Takigami, MD, PhD, Osaka JAPAN
Hiroaki Nakamura, Prof., Osaka JAPAN
Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Osaka, JAPAN
FDA Status Not Applicable
Summary: One third of patients who has used meniscal repair device FasT-Fix generated cyst around implant. Using FasT-Fix alone was high risk for generating cyst compared with FasT-Fix with inside-out suture.
The FasT-Fix is widely used as a useful meniscal repair device around the world. We encountered a patient who had surgery to remove a cyst that had developed after treatment with the FasT-Fix. We have therefore designed a retrospective study to investigate the possibility of FasT-Fix related cyst using MRIs.
Of the patients who had undergone meniscal repair surgery in the Osaka City University Hospital between August 2008 and October 2012, 41 cases (41 knees) were selected to be in the study. Each knee has medial and lateral meniscus. If patient was used FasT-Fix for medial and lateral meniscus, we consider that there are two menisci. In the end, 47 menisci of 41 cases (41 knees) were included to the study.
MRIs of the knee were performed 6 months, 12 months and 24 months post-meniscal surgery. The MRIs were examined for new development of cysts encasing the anchors from the FasT-Fix devices. Statistical analysis was used to account for the suture technique, concurrent operation, patient gender, medial versus lateral menisci, number of device use and type of anchor.
Out of the 47 menisci examined, 3 cases developed cysts within 6 months of surgery, 14 cases developed cysts within 12 months, and 17 cases developed cysts within 24 months. Only 3 patients were symptomatic. Compared with FasT-Fix with inside-out suture, using FasT-Fix alone were more likely to generate cyst: the adjusted odds ratio (OR) of subject with FasT-Fix with inside-out suture was 10.67 (95% confidence interval (CI) 1.25 to 91.41) compared with FasT-Fix alone. The number of FasT-Fix use was also associated with cyst formation: OR of subject with = 2 use of FasT-Fix was 5.73 (95% confidence interval (CI) 1.11 to 29.63) compared with 1 use of FasT-Fix. There were no statistical differences found regarding the remaining variables.
There have been several documented cases of cyst formation to the use of meniscal repair devices in the past but only as case reports. In our study, one third of the patients generated cyst around suture implant of the FasT-Fix however most cases don’t have any symptoms. In the statistical analysis, subject of Fast-Fix without inside-out suture strongly affected cyst generation. Beside the number of use of the FasT-Fix also lead to cyst generation. It may indicate that strength of the FasT-Fix is not enough for repairing menisus. Rates of cyst formation may possibly be reduced with the use of the FasT-Fix 360 which has smaller suture implants, combined use of inside-out suture techniques, and adequate spacing to prevent anchors from abrading with one another.