Meniscal repair devices: A clinical and biomechanical literature review

Purpose: The development of new approaches to arthroscopic meniscal repair has spurred the concomitant publication of studies reviewing their use and biomechanical properties. The purpose of this article is to review both the devices and the literature surrounding their clinical and biomechanical properties. Type of Study: Literature review. Methods: Studies were initially gathered using a MEDLINE search, and additional information was found through cross references. We evaluate a series of studies comparing sutures, suture anchors, screws, staples, and a variety of other devices in terms of initial fixation strength, degradation profile, performance under cyclical loading, and clinical success. Results: In the traditional suture studies, vertical sutures are clearly superior to both horizontal sutures and knot-end techniques in terms of initial fixation strength and performance under cyclical loading. Unfortunately, multidevice studies have been less consistent and less conclusive. the Linvatec Biostinger, Smith & Nephew T-fix, and Bionx Meniscus Arrow have separately been shown to have superior initial fixation strength on par with suture techniques. After cyclical loading, horizontal sutures, vertical sutures, 16-mm Arrows, 13-mm Arrows, and the Smith & Nephew T-fix generally show higher fixation strengths. Only the Bionx Arrow, Linvatec Biostinger, and Clearfix Screw have been shown to retain their initial fixation strengths through four months of hydrolysis time. Conclusions: Data suggest that the biomechanical performance of some devices is nearly equivalent to current suture techniques. Ultimately, the combination of a simplified surgical technique, high clinical healing rates (75%-92%), and relatively minor complications makes these devices attractive for properly indicated meniscal tears.