Suture Versus FasT-Fix All-Inside Meniscus Repair at Time of Anterior Cruciate Ligament Reconstruction

Purpose: To compare meniscal healing and functional outcomes after all-inside meniscal repair between sutures and meniscal fixation devices. Methods: Sixty patients with a tear within the red-red or red-white zones of the posterior horn of the medial or lateral meniscus in conjunction with an anterior cruciate ligament (ACL) tear were included in this study. Meniscal repairs were performed with sutures in 35 patients and the FasT-Fix device (Smith & Nephew Endoscopy, Andover, MA) in 25 patients concomitantly with hamstring ACL reconstruction. Postoperative evaluations included Lysholm knee score, Tegner activity scale, Lachman and pivot-shift tests, and KT-1000 arthrometer (MEDmetric, San Diego, CA) testing. Follow-up magnetic resonance imaging (MRI) scans were obtained postoperatively for all patients to evaluate meniscal healing. Results: The mean follow-up period was 47.2 months. In the suture group, 31 patients (86.1%) were asymptomatic and 4 (13.9%) were symptomatic. In the FasT-Fix group, 20 patients (80%) were asymptomatic and 5 (20%) were symptomatic. Postoperative functional evaluation and knee stability showed no statistically significant difference between the 2 groups. Follow-up MRI showed that 26 menisci (74.3%) were healed, 3 menisci (8.6%) were partially healed, and 6 menisci (17.1%) were not healed in the suture group. In the FasT-Fix group, 15 menisci (64%) were healed, 7 menisci (24%) were partially healed, and 3 menisci (12%) were not healed. Follow-up MRI showed no statistically significant difference between the 2 groups. In the FasT-Fix group, follow-up MRI showed a newly developed cyst posterior to the medial meniscus in 2 patients. A new tear anterior to the previous tear was found in 1 patient. In the suture group, follow-up MRI showed no cysts or new tears. Conclusions: All-inside meniscal repairs using either sutures or the FasT-Fix device showed satisfactory results in patients with concomitant hamstring ACL reconstruction. There was no statistically significant difference in meniscal healing evaluated by MRI and functional outcomes between the 2 techniques.