Meniscal Repair: A Randomized Prospective Trial of FAST-FIX vs. Meniscal Suturing

• Quality of life at 2 years as measured by The Western Ontario Meniscal Evaluation Tool (WOMET)
  

• Side-to-side difference in knee joint range of motion
  
• Other physical symptoms such as joint line pain/tenderness, knee effusion
  
• Re-tear rate (as confirmed by MRI or arthroscopy), Functional outcome scores
  
• Surgical time
  
• Complication rate
  
• Differences between groups in post-operative pain
  

In this prospective, randomized, trial subjects will be randomly assigned to the inside-out group or the FasT-Fix group and will be followed for at least 24 months. Primary outcome is the difference between groups in the disease specific quality of life assessment – The Western Ontario Meniscal Evaluation Tool. Secondary outcome measures include range of motion, functional outcome scores, surgical time, complication rate, meniscal retear and differences between groups in post-operative pain. The data collector will be blinded to patients’ intervention group. Secondary outcome measures include range of motion, functional outcome scores, disease-specific quality of life outcome scores and the standard knee clinical examination.

Study Population: The investigators will assess all patients presenting with suspected meniscal tears. Those meeting the inclusion/exclusion criteria will be asked to sign an informed consent. Subjects who have successfully been screened and are slated to be randomized into the study must have a pre-operative visit within 12 months of their scheduled surgery.

Routine knee x-rays will be performed on all patients to rule out extensive degenerative changes, loose bodies, fractures, osteochondritis dissecans and other lesions.

Treatment Protocols: Intervention group assignment will take place at the time of surgery, once the patient has undergone the initial arthroscopy and a diagnosis of a repairable meniscal tear has been confirmed. Patients will be stratified for surgeon and for concurrent ACL reconstruction. They will then be randomized to one of the two treatment groups.

Meniscal repair is a day surgery procedure performed under general anaesthesia and tourniquet control as required. Prior to the repair, synovial abrasion and debridement of scar tissue will be carried out to promote vascular ingrowth.

FasT-Fix Technique A suture that is pre-attached to a T-bar is placed across the meniscal tear via a sheathed needle. A small obturator pushes the “T” out of the needle engaging the outer rim of the meniscus in the synovial recess. The suture tails are tied arthroscopically, stabilizing the tear.

Inside-Out Suturing Technique Repairs of the medial meniscus will be carried out with the knee in 10-30° flexion. This allows both preservation of the posterior capsular recess and full knee extension once the repair is complete. A vertical incision is made posterior to the medial collateral ligament. The deep fascia is incised and the posteromedial capsule visualized. The lateral meniscus is repaired through a vertical incision posterior to the lateral collateral ligament made with the knee flexed 90°. The iliotibial band is split in line with its fibers at the level of the joint line. The biceps femoris and lateral gastrocnemius tendon are retracted posteriorly, protecting the common peroneal nerve and exposing the capsule and popliteus tendon. Vertical sutures will be placed in at 5mm intervals along the tear. Sutures are tied over the capsule once ligamentous reconstruction, if necessary, is completed. This is done with the knee in full extension.

Assessments: Patients will be assessed pre-operatively and by a blinded research assistant at 3, 6, 12, and 24 months. A tubi-grip will cover the operative knee in order that the data collector may be blinded to treatment group. Effusion and joint-line tenderness will be assessed by the physician prior to the data collector’s appraisal. The viability of the meniscal repair will be based on the clinical examination. The absence of effusion, joint-line tenderness and locking all correlate well with a healed meniscus. The International Knee Documentation Form, the Western Ontario Meniscal Evaluation Tool and the Lysholm score, validated measures for knee problems will be utilized. Patients will be asked to complete a pain journal for a period of 2 weeks following their surgery.