Meniscal repair using the FasT-Fix all-inside meniscal repair device
Meniscal repair using the FasT-Fix all-inside meniscal repair device
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DOI：
10.1016/j.arthro.2004.10.012
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发表时间：
2005-02-01
影响因子：
4.7
通讯作者：
Edgar, CM
中科院分区：
文献类型：
--
作者：
Haas, AL;Schepsis, AA;Edgar, CM
目的：我们采用一种新型全内缝合半月板修复装置进行半月板修复的前瞻性研究，评价其临床疗效。研究类型：前瞻性病例系列。方法：对37例使用FasT-Fix装置进行半月板修复的42例半月板撕裂患者（Smith & Nephew, Andover， MA）的结果进行前瞻性评估。所有病例均由1名外科医生（A.A.S.）进行手术。术前和随访评估采用客观和主观的国际膝关节文献委员会（IKDC）标准以及Lysholm功能问卷进行。经双尾t检验，P < 0.05为统计学显著性。8例患者行关节镜检查（9例修复）。任何进行混合修复的患者都被排除在外。结果：研究的患者群体，37例患者包括42例半月板修复，平均年龄为27岁（范围，13至48岁），平均随访24.3个月（范围，22至27个月）。男20例，女20例，内侧修复23例，外侧修复9例，双半月板修复5例。所有患者在库珀桡侧1区和2区均有撕裂，因此周围半月板边缘至少为2mm。所有撕裂主要发生在半月板的中间和后三分之一，8个撕裂延伸到半月板前三分之一的最后方。平均使用2.8个缝合装置（范围，1至5），主要是垂直或垂直倾斜床垫配置。42%为孤立的半月板损伤，58%为并发前交叉韧带（ACL）重建。伴随手术包括前交叉韧带重建22例，松体切除1例，大半月板囊肿切除1例。撕裂长度平均2.9 cm（范围1.5 ~ 4.5 cm）。客观IKDC评分成功率为86%（73%正常，13%接近正常，14%异常）。5例临床失败中，孤立组3例（成功率80%），ACL组2例（成功率91%）。主观IKDC和Lysholm评分均有统计学上的提高（IKDC平均，术前59分，术后92分；Lysholm平均，术前69分，术后94分）。有8例关节镜复查，5例失败，3例其他手术完全愈合。在任何情况下，这些结都没有造成关节的磨损。5例T-Fix棒接合失败，手术时必须移除装置。然后在每个病例中插入一个额外的FasT-Fix装置，没有困难。术后无一例关节外或关节内并发症。结论：FasT-Fix缝合装置提供了一种全内部的半月板修复方法，使用强大的垂直或水平床垫缝合配置，似乎是一种安全有效的半月板撕裂修复技术，至少有2毫米的周边边缘。其成功率高，并发症发生率低，效果可与经典缝合修复技术相媲美。
Purpose: We performed a prospective study of meniscal repair using a new all-inside suture meniscal repair device to evaluate its clinical efficacy. Type of Study: Prospective case series. Methods: The results of 42 meniscal tears in 37 patients who underwent meniscal repair using the FasT-Fix device (Smith & Nephew, Andover, MA) were prospectively evaluated. All cases were performed by 1 surgeon (A.A.S.). Preoperative and follow-up evaluation was performed using the objective and subjective International Knee Documentation Committee (IKDC) criteria as well as Lysholm functional questionnaires. Statistical significance was determined to be P < .05 based on a 2-tailed t test. Relook arthroscopy was performed in 8 patients (9 repairs). Any patient who had a hybrid repair was excluded. Results: The patient population studied, 37 patients comprising 42 meniscal repairs, had an average age of 27 years (range, 13 to 48 years), and an average follow-up of 24.3 months (range, 22 to 27 months). There were 20 male and IS female patients with 23 medial and 9 lateral repairs, 5 patients had both menisci repaired. All patients had tears in Cooper radial zones 1 and 2 and, thus, had a peripheral meniscal rim of at least 2 mm. All tears were predominantly in the middle and posterior third of the meniscus and 8 tears extended into the posteriormost aspect of the anterior third of the meniscus. An average of 2.8 suture devices was used (range, 1 to 5), predominately in a vertical or vertical oblique mattress configuration. Forty-two percent were isolated meniscal injuries and 58% had a concurrent anterior cruciate ligament (ACL) reconstruction. Concomitant procedures were ACL reconstruction in 22, excision of loose body in 1, and excision of a large meniscal cyst in 1. Tear length averaged 2.9 cm (range, 1.5 to 4.5 cm). The success rate by objective IKDC score was 86% (73% normal, 13% nearly normal, and 14% abnormal). Of the 5 clinical failures, 3 were in the isolated group (80% success rate), and 2 were in the ACL group (91% success rate). Both the subjective IKDC and the Lysholm scores statistically improved (IKDC average, 59 preoperative and 92 postoperative; Lysholm average, 69 preoperative and 94 postoperative). There were 8 relook arthroscopies, 5 for failures and 3 for other procedures at which time complete healing was noted. In no case was there articular scuffing from the knots. Removal of a device at the time of surgery was necessary in 5 instances for failure of engagement of the T-Fix bar. An additional FasT-Fix device was then inserted without difficulty in each case. No case of postoperative extra-articular or intra-articular complications was encountered. Conclusions: The FasT-Fix suture device affords an all-inside method of meniscal repair using a strong vertical or horizontal mattress suture configuration and appears to be a safe and effective technique for meniscal repair for tears with at least a 2-mm peripheral rim. It has a high success rate and low complication rate and has results comparable to classic suture repair techniques.