Clinical Sports Medicine Update

All-Inside Repair of Bucket-Handle

Meniscal Tears
Clinical Outcomes and Prognostic Factors
Carolyn A. Ardizzone,*y MS, Darby A. Houck,y BA, Derek W. McCartney,y MS,
Armando F. Vidal,z MD, and Rachel M. Frank,y MD
Investigation performed at University of Colorado School of Medicine,
Department of Orthopedics, Division of Sports Medicine and Shoulder Surgery,
Aurora, Colorado, USA

Background: There is no consensus on technique of choice for repair of bucket-handle meniscal tears (BHMTs).
Purpose: To determine factors that affect patient outcomes and failure rates in patients undergoing all-inside repairs of BHMTs.
Study Design: Systematic review.
Methods: A systematic review of 3 databases using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-
Analyses) guidelines was performed. All English-language literature from 1993 to 2019 describing clinical outcomes for patients
undergoing all-inside BHMT repair with 12-month follow-up was reviewed by 2 independent reviewers. Patient characteristics
(patient sex, age), intraoperative factors (laterality, concomitant procedures, surgical technique, implants utilized), and postoperative
outcomes (failure rates) were analyzed. Study quality was evaluated with the Modified Coleman Methodology Score (MCMS).
Results: Fifteen studies (1 level 1, 4 level 3, 10 level 4) with 763 total patients (64% male; average age, 26.4 years [range, 9-58
years]; average follow-up, 39.8 months [range, 12-120 months]) including 396 all-inside BHMT repairs were included. Six devices
were used for repair including the Meniscal Repair System, FasT-Fix, Meniscus Arrow, Biofix Arrow, RapidLoc device, and PDS II
suture, with failure rates of 13.5%, 22.4%, 27.1%, 42.9%, 45.2%, and 0%, respectively. The overall repair failure rate was 29.3%
at an average of 13.0 months (range, 5.0-32.4 months), but 19.0% for devices still in use. The RapidLoc and Biofix Arrow had
higher failure rates than other devices (P = .0003). Women (31%) were less likely to experience a failure than were men (69%)
(P = .03). Longer follow-up duration resulted in higher failure rates (.30 months, 34.4%; \30 months, 23.4%; P = .016). In 4 stud-
ies reporting on both all-inside and inside-out repairs, no significant differences in failure rates were observed. No significant dif-
ferences in failure rates were found between medial and lateral repairs nor repair with and without concurrent anterior cruciate
ligament reconstruction (P . .05 for all). The overall average MCMS was 54.4 6 12.
Conclusion: The overall failure rate after all-inside repair of BHMTs is 29.3% at an average of 13.0 months, with no difference in
failure rates between medial and lateral meniscal repairs. The variables shown to negatively affect the failure rates were the Rap-
idLoc and Biofix Arrow, male sex, and longer follow-up duration.
Keywords: meniscus; all-inside; bucket-handle; arthroscopic

The fibrocartilaginous lateral and medial menisci serve as degenerative knee changes, and increased pressure loads as
proprioceptors, stabilizers, and pressure distributers in the compared with newer meniscal preservation and repair tech-
tibiofemoral joint.18,44,45 Meniscal injuries can result from niques,6,18,28 and meniscal repair is now attempted whenever
trauma, degeneration, or congenital malformation,7 and they possible. Within the past 25 years, meniscal repair has
are one of the most common types of surgically repaired evolved from open procedures to arthroscopic procedures,
knee injury in the United States.1 From 18834 to the 1970s, with arthroscopic procedures coming into greater favor
the mainstay of meniscal injury management was partial because of their quicker recovery and rehabilitation times
or complete meniscectomy.9 That began to change as new and fewer complications.26,43 The 3 arthroscopic techniques
evidence arose demonstrating worse clinical outcomes, used today are the inside-out repair, outside-in repair, and
all-inside repair. Although the inside-out repair remains the
gold standard of meniscal repairs because of its proven success
in a variety of meniscal zones,14,15,38 the outside-in technique
The American Journal of Sports Medicine
can be useful for anterior tears that are hard to reach
1–8
DOI: 10.1177/0363546520906141 through arthroscopic portals,21 and the all-inside technique
Ó 2020 The Author(s) has become increasingly popular since the introduction of

1
2 Ardizzone et al The American Journal of Sports Medicine

the Meniscus Arrow (Bionx Implants Inc) in 1993.3 The all- types were inseparable from the all-inside repairs of BHMTs
inside technique has shown reduced operative times, specifically. The corresponding authors of many of those
quicker patient recovery, and fewer potential neurovascular papers were contacted, and includable data from 1 of
complications, especially with tears of the posterior them34 was obtained and included. Fifteen studies§ were
horn.3,5,19,25 included in the final review (Figure 1).
Although tear location is a large determining factor in
choosing which technique to use, tear type also plays Data Extraction
a role. Bucket-handle meniscal tears (BHMTs), defined as
vertical longitudinal tears that can be displaced toward Data on patient characteristics, follow-up duration, devices
the intercondylar notch, often present with a locked knee and techniques utilized, meniscal tear location, concurrent
and pose a particular challenge for surgeons. Data suggest surgeries, and failure rates were compiled and consolidated.
that BHMTs demonstrate worse clinical outcomes than
smaller vertical longitudinal tears after meniscal repair.32,33 Study Methodology Assessment
As such, using the optimal repair technique for BHMTs is
critically important. Because of the lack of definitive clinical Study methodological quality was evaluated with the Mod-
data regarding the best technique to use for these tears, ified Coleman Methodology Score (MCMS).13 MCMS is
however, technique choice is largely determined by surgeon a quality assessment tool with output scores ranging
preference. Because the all-inside technique necessitates 1 from 0 to 100, with a score of 100 indicating that the study
fewer incision and assistant compared with the inside-out largely avoids chance, biases, and other confounding fac-
technique,35 it might be the preferred choice if clinical out- tors. Scores of 85 to 100 are considered excellent, 70 to
comes are comparable. So far, the clinical outcomes data 84 are good, 55 to 69 are fair, and less than 55 are poor.
for the all-inside repair of BHMTs have been mixed. While
tear vascularity, chronicity, and size all factor into the like- Statistical Analysis
lihood of a successful repair,11 our goal was to review the
current literature addressing clinical outcomes and prog- Analyses were done by chi-square test to compare categor-
nostic factors regarding the all-inside repair of BHMTs. ical variables and linear regression to characterize the
relationship between follow-up duration and failure rate.
Statistical significance was set at a = .05.
METHODS

Literature Search RESULTS

This systematic review was conducted in accordance with the Study Characteristics
PRISMA (Preferred Reporting Items for Systematic Reviews
and Meta-Analyses) guidelines using a PRISMA checklist.27 Fifteen studies§ including 396 all-inside repairs for the
Two independent reviewers (C.A.A., D.W.M.) conducted treatment of BHMTs were included (Table 1). Saltzman
a search using PubMed, EMBASE, and the Cochrane Library et al.34 was included in the results because its original
up to May 15, 2019. The following search terms were used: 2018 publication met inclusion criteria for the search.
‘‘all inside meniscus repair,’’ ‘‘all-inside meniscus repair,’’ Patient age ranged from 937 to 5842 years with an average
‘‘all inside meniscal repair,’’ ‘‘all-inside meniscal repair,’’ of 26.4 years across the 15 included studies, and 64% of the
and ‘‘bucket-handle.’’ A total of 1661 studies were reviewed patients were men. The average patient follow-up ranged
by title and/or abstract to determine study eligibility based between 1224 and 12039 months within the studies, with
on inclusion criteria. In the event of disagreement, the final an overall average follow-up of 39.8 months.
decision was made by a third reviewer (D.A.H.). Inclusion cri-
teria were English-language studies from 1993 to 2019 that Study Quality
reported clinical outcomes for all-inside repairs of BHMTs
with no less than 12 months of average follow-up. Exclusion Most of the studies included in this review were retrospec-
criteria included review articles, presentation abstracts, bio- tive or prospective case series. Specifically, 1 study23 was
mechanical studies, and editorials. Studies were also
§
excluded if data involving additional repair methods or tear References 2, 8, 16, 22-24, 30, 31, 34-37, 39, 40, 42.

*Address correspondence to Carolyn A. Ardizzone, MS, Department of Orthopedics, Division of Sports Medicine and Shoulder Surgery, University of
Colorado School of Medicine, CU Sports Medicine and Performance Center, 2150 Stadium Drive, Rm 222, Boulder, CO 80309, USA (email: Carolyn
.Ardizzone@colorado.edu) (Twitter: @CUsportsmed).
y
Department of Orthopedics, Division of Sports Medicine and Shoulder Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA.
z
The Steadman Clinic, Vail, Colorado, USA.
Submitted October 11, 2019; accepted December 12, 2019.
One or more of the authors has declared the following potential conflict of interest or source of funding: R.M.F. has received speaking fees from Arthrex
Inc and publishing royalties and financial or material support from Elsevier. A.F.V. has received other financial or material support and consulting fees from
Smith & Nephew and Stryker; education payments and compensation for services other than consulting from Arthrex; and hospitality payments from Steris
Corp. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the
OPD and disclaims any liability or responsibility relating thereto.
AJSM Vol. XX, No. X, XXXX All-Inside Repair of Bucket-Handle Meniscal Tears 3

Figure 1. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram.

TABLE 1
Study Characteristics of the 15 Studies Included in the Reviewa

Level of Total Patients Patients With AI Average Mean or Median

Authors Year Evidence (Total Repairs) BH Repairs (% Total) Devices Used Follow-up, mo Patient, y

Laprell et al24 2002 3 37 (37) 37 (100) Mitek MRSf 12 27

Jones et al22 2002 4 38 (39) 19 (49) Meniscus Arrow 29.7 30
Petsche et al30 2002 4 29 (29) 9 (31) Meniscus Arrow 24 29
Spindler et al40 2003 3 125 (125) 14 (11) Meniscus Arrow 40.1 24
Ahn et al2 2004 4 39 (39) 4 (10) PDS II suture 20 31
Sarimo et al36 2005 3 20 (21) 21 (100) Meniscus Arrow 26 26
Quinby et al31 2006 4 46 (54) 4 (7) RapidLoc 34.8 26
Tielinen et al42 2007 4 73 (77) 77 (100) Meniscus Arrow 25 31
Feng et al16 2008 4 64 (67) 3 (4) PDS II suture 25 25
Billante et al8 2008 4 30 (38) 7 (18) RapidLoc 30.4 29
Kise et al23 2015 1 46 (46) 46 (100) Biofix Arrow, FasT-Fix 24 26
Solheim et al39 2016 4 82 (82) 82 (100) RapidLoc 120 33
Schmitt et al37 2016 4 19 (19) 9 (47) FasT-Fix 72 15
Samuelsen et al35 2018 3 40 (40) 20 (50) FasT-Fix 52.8 23
Saltzman et al34 2020 4 75 (78) 44 (56) FasT-Fix 23.4 27
763 (791)c 396 (50)c 39.8b 26.4b

a
AI, all-inside; BH, bucket-handle; MRSf, Meniscal Repair System fastener.
b
Weighted mean.
c
Total.
4 Ardizzone et al The American Journal of Sports Medicine

TABLE 2 some studies distinguished clinical failure from retear or

Study Quality and Failure Definitiona reoperation,{ while others2,8,42 did not (Table 2). Whenever
it was possible to separate clinical failure from retear or
Level of reoperation, only the latter were considered failures. Both
Authors Evidence MCMS Failure Definition
definitions of failure were combined for an overall failure
Kise et al 23
1 78 Reoperation rate of 29.3% at an average of 13.0 months for the all-inside
Sarimo et al36 3 51 Reoperation or repeat repair of BHMTs in these studies (Table 3).
arthroscopy
Samuelsen et al35 3 46 Retear Device
Spindler et al40 3 73 Reoperation
Laprell et al24 3 49 Retear The device-specific failure rates were 0% for the PDS II
Tielinen et al42 4 62 Reoperation or clinical
suture, 13.5% for the Mitek MRSf, 22.4% for the FasT-Fix
Solheim et al39 4 71 Reoperation
meniscal repair system, 27.1% for the Meniscus Arrow,
Schmitt et al37 4 51 Reoperation
Quinby et al31 4 60 Reoperation 42.9% for the Biofix Arrow, and 45.2% for the RapidLoc
Jones et al22 4 53 Reoperation meniscal repair device. There was a significant difference
Feng et al16 4 43 Repeat arthroscopy in the failure rates for the different devices (P = .0003),
Billante et al8 4 53 Reoperation or clinical with the RapidLoc device and the Biofix Arrow performing
Ahn et al2 4 39 Clinical or repeat significantly worse than the others (Table 4, Figure 2). The
arthroscopy devices currently in use or with subsequent generations still
Petsche et al30 4 47 Reoperation or repeat in use are the FasT-Fix, PDS II suture, and Mitek MRSf,
arthroscopy which have a combined failure rate of 19.0% (n = 142).
Saltzman et al34 4 40 Retear

a
Level of evidence and Modified Coleman Methodology Score Sex
(MCMS) for the 15 studies included in the review along with their
characterization of meniscal repair failure. Although every study but one42 reported overall sex ratios,
only 2 studies34,39 reported specific statistics for BHMTs.
In these studies, women (31%; n = 40) had a failure rate
level 1 evidence, 4 studies24,35,36,40 were level 3, and 10 of 25.7% and were significantly less likely to experience
studiesk were level 4. The MCMS average was 54.4 6 12 a failure than were men (69%; n = 90) (P = .03), whose fail-
(range, 39-78), with the majority falling in the ‘‘fair’’ range ure rate was 47.8% (Table 5, Figure 3).
(Table 2).

Laterality
Repair Devices
Nine studies reported laterality failure statistics, but just 4
The devices used for all-inside repairs varied from study to studies2,36,37,39 had separable BHMT statistics (Table 5). In
study. Six different devices were used in these studies; the these studies, there was no significant difference between
Meniscal Repair System fastener (MRSf) (Mitek Products) failure rates of medial (42.4%; n = 38) and lateral (45.5%;
was used in 1 study,24 as was the Biofix Arrow23 (Bionx n = 10) meniscal repairs (P . .05) (Figure 3).
Implants Ltd). PDS II (polydioxanone) sutures (Ethicon)
were used in 2 studies,2,16 the RapidLoc device (DePuy
Concurrent Surgeries
Mitek) was used in 3 studies,8,31,39 a FasT-Fix device
(Smith & Nephew) was used in 4 studies,23,34,35,37 and Eight studies2,24,31,34,36,39,40,42 reported statistics for ACL
Meniscus Arrows were used in 5 studies22,30,36,40,42 (Table injuries and reconstructions, which were all used in our anal-
1). Both first and second generations of the FasT-Fix ysis (Table 5). In all but 1 study,24 ACL reconstructions were
device and Meniscus Arrow were utilized in the studies. done concurrently with the meniscal repairs. Laprell et al24
Since there was no significant difference between failure performed ACL reconstructions 6 to 8 weeks after the initial
rates between the 2 generations, the 2 generations were meniscal repairs. There was no significant difference in fail-
combined in the failure rate analysis because of ambiguity ure rates between those who had an isolated meniscal repair
regarding which generation was used in at least 1 study.42 (35.3%; n = 61) and those who underwent concurrent ACL
reconstruction (27.3%; n = 30) (P . .05) (Figure 3).
Failure Rates
Follow-up
Differences in failure rates were compared for variables
including patient sex, devices used, medial versus lateral All 15 studies# reported study-wide average or median fol-
meniscal repair, status of concurrent anterior cruciate liga- low-up duration (Table 5). Linear regression was used to
ment (ACL) reconstruction, and follow-up duration. Fail- detect the relationship between follow-up duration and
ures were similarly defined between the studies, with failure rate (Figure 4). The studies were subsequently split
reoperation considered a failure in all cases. However,
{
References 16, 22-24, 30, 31, 34-37, 39, 40.
k #
References 2, 8, 16, 22, 30, 31, 34, 37, 39, 42. References 2, 8, 16, 22-24, 30, 31, 34-37, 39, 40, 42.
AJSM Vol. XX, No. X, XXXX All-Inside Repair of Bucket-Handle Meniscal Tears 5

TABLE 3
RapidLoc
Failure Rates and Time to Failurea
Biofix Arrow
BH Failures, Average Time *
Authors n/N (%) to Failure, mo Meniscus Arrow
* *
* *
24
Laprell et al 5/37 (13.5) 7.6 *
FasT-Fix
Jones et al22 2/19 (10.5) 17.5
Petsche et al30 2/9 (22.2) 5.0 MRSf
Spindler et al40 1/14 (7.1) 18.0
Ahn et al2 0/4 (0.0) 12.0 PDS II Suture
Sarimo et al36 7/21 (33.3) 10.5
0 10 20 30 40 50 60
Quinby et al31 2/4 (50.) 21.8
Failure Rate (%)
Tielinen et al42 26/77 (33.8) 14.0
Feng et al16 0/3 (0.0) N/A
Billante et al8 1/7 (14.3) N/A Figure 2. Failure rates of the 6 all-inside devices used for
Kise et al23 12/46 (26.1) 13.8 meniscal repair. An asterisk denotes statistical significance
Solheim et al39 39/82 (47.6) 12.2 (P \ .05). MRSf, Meniscal Repair System fastener; PDS, pol-
Schmitt et al37 2/9 (22.2) N/A ydioxanone suture.
Samuelsen et al35 4/20 (20.0) 32.4
Saltzman et al34 13/44 (29.5) 12.2
Overall 116/396 (29.3) 13 TABLE 5
a
Failure Rates by Sex, Follow-up,
BH, bucket-handle; N/A, not available. ACL Status, and Lateralitya

Factors Total Failures (%) P Value

TABLE 4
Sex .03
Failure Rates of All-Inside Devicesa
Male 90 43 (47.8)
Repair Device No. of BH Repairs Failures (%) Female 40 11 (27.5)
Follow-up, mo .016
RapidLoc 93 42 (45.2) \30 184 43 (23.4)
Biofix Arrow 21 9 (42.9) .30 212 73 (34.4)
Meniscus Arrow 140 38 (27.1) ACL status .16
FasT-Fix 98 22 (22.4) Reconstruction 110 30 (27.3)
MRSf 37 5 (13.5) No reconstruction 173 61 (35.3)
PDS II suture 7 0 (0) Laterality .78
Total 396 116 (29.3) Medial 90 38 (42.2)
Lateral 22 10 (45.5)
a
Total repairs and failures for each device and their correspond-
a
ing failure rates. BH, bucket-handle; MRSf = Meniscal Repair Sys- Total number of repairs and failures for each of the 4 variables
tem fastener; PDS, polydioxanone suture. and their corresponding failure rates. Boldface type denotes statis-
tical significance (P \ .05). ACL, anterior cruciate ligament.

in half to determine significance by chi-square. Stud-

ies2,16,22,24,30,36,40,42 with an average or median follow-up
duration of \30 months (53%; n = 8) had significantly with no difference in failure rates between medial and lat-
lower rates of failure than studies8,23,31,34,35,37,39 with an eral meniscal repairs. The variables shown to negatively
average or median follow-up duration of .30 months affect the failure rates were the RapidLoc device and the
(47%; n = 7) (P = .016) (Table 5). Biofix Arrow, male sex, and longer follow-up duration.
This may suggest that failure rates are underestimated
in studies with \30 months follow-up and, thus, would
Inside-Out Repair Comparison be higher with longer-term follow-up.
One area in which we found no difference, but that has
Four studies16,34,35,40 reported on both inside-out and all-
historically been found to affect failure rates in short-term
inside repairs of BHMTs. All-inside repairs had a failure
studies, is ACL reconstruction status. Several studies have
rate of 17.1% with 13 out of 76 repairs failing, while
demonstrated better outcomes when meniscal repair is
inside-out repairs had a failure rate of 17.2% with 15 of 87
done concurrently with ACL reconstruction,12,20,38,41 but
repairs failing. There was no significant difference in failure
these studies have short follow-up durations. The benefit
rates between the techniques in these studies (P = .98).
of concurrent ACL reconstruction has been believed to be
due in part to the increased blood accumulation from the
DISCUSSION surgically induced trauma.12 A more recent systematic
review by Nepple et al29 looking at factors affecting menis-
We found that the overall failure rate after all-inside cal repair failure rates at greater than 5 years of
repair of BHMTs was 29.3% at an average of 13.0 months follow-up found no difference in failure rates between those
6 Ardizzone et al The American Journal of Sports Medicine

Female 60
Gender *
Male
50
R² = 0.4478

Failure Rate (%)

< 30 mo. 40
Follow-up *
> 30 mo.
30

Concurrent ACL
20
Reconstrucon No ACL
10
Medial
Meniscus 0
Lateral
0 20 40 60 80 100 120 140
0 5 10 15 20 25 30 35 40 45 50
Failure Rate (%)
Average Follow-up (months)

Figure 3. Factors affecting failure rates. An asterisk denotes Figure 4. Relationship between studies’ average follow-up
statistical significance (P \ .05). duration and meniscal repair failure rate via linear regression.

with isolated meniscal repairs and those undergoing con- rates between the techniques, with clinical and anatomic
current ACL reconstruction. Considering that our current failures of 10% and 16% for all-inside repairs, and 11%
review includes studies with an average follow-up of and 13% for inside-out repairs, respectively. Four of the
more than 3 years, it might be worthwhile to look further studies included in our review had data for both inside-
into the role that time plays in the relationship between out and all-inside repairs, which allowed for a more direct
meniscal repair and concurrent ACL reconstruction. comparison of the 2 techniques for BHMTs. Importantly,
With an overall failure rate of 29.3%, our findings sug- the failure rates of the techniques were almost identical,
gest that the outcomes of all-inside repair might be less demonstrating that the all-inside repair seems to perform
favorable than those of the inside-out repair when used equally well within studies. Combined with the lower inci-
for BHMTs. A systematic review by Grant et al19 in 2012 dence of complications with the all-inside repair, this tech-
found a 17% failure rate in 8 studies reporting on inside- nique appears to be a good choice for BHMT repair when
out repairs for isolated BHMTs. The authors restricted using a suitable device.
their analysis to repairs in the red-red or red-white zones
and only required 3 months of follow-up, which may have
resulted in a more favorable failure rate compared with Limitations
the results of our study. This is because highly vascular
regions of the meniscus allow for better healing and short It is important to keep in mind that the MCMS of the stud-
follow-up durations do not catch failures that occur later, ies included in this review limit our ability to draw defini-
as our current study suggests. To enable accurate compar- tive conclusions. While 396 patients undergoing all-inside
isons of failure rates between studies, future studies repair for the treatment of BHMTs were included in this
should ensure sufficient follow-up duration. Saltzman systematic review, the meniscal repair devices varied
et al34 used a Kaplan-Meier curve to conduct survival anal- from study to study, and sample sizes were therefore lim-
ysis in their 2018 study, concluding that failure rates ited for particular outcomes. Since data were not presented
steadily increase until 15 months.34 As such, this time in such a way to allow logistic regression analysis, our find-
point should be considered the minimum necessary ings are purely correlative. Furthermore, data for sex and
follow-up duration. laterality were extractable from only 2 and 4 studies,
Although we found that the overall failure rate for respectively. Although the Meniscus Arrow went through
BHMTs is higher for all-inside repairs than inside-out at least 2 generations, we were unable to stratify based
repairs, we also found that all-inside repair outcomes on generation because of the ambiguity of generation
vary by device, and the devices associated with better out- used in at least 1 of the studies.42 While there were not sig-
comes had failure rates commensurate with those of nificant differences between the device generations with
inside-out repairs.19 Our findings corroborate previous bio- the numbers in the studies we assessed, second-generation
mechanical studies demonstrating better durability of devices have been found collectively to be stronger than
sutures than other methods.10 Furthermore, some of the first-generation devices.10 Additionally, because of the
older devices that performed poorly in our analysis are wide variation in the reporting of complications, we were
no longer commonly used in practice. The combined failure unable to determine overall complication rates, which
rate for the devices still in use or with subsequent genera- should always be a significant consideration for determin-
tions still in use is 19.0%, which supports the notion that ing which surgical technique to use for meniscal repair.
the all-inside repair is a reasonable alternative to the Finally, the definition of clinical failure was not consis-
inside-out repair for BHMTs. A 2017 study by Fillingham tently distinguished from retear or reoperation, which ulti-
et al17 looking at all-inside versus inside-out repairs for mately limits the ability to determine the healing rate
all types of meniscal tears found no difference in failure without secondary imaging or second-look arthroscopy.
AJSM Vol. XX, No. X, XXXX All-Inside Repair of Bucket-Handle Meniscal Tears 7

CONCLUSION 19. Grant JA, Wilde J, Miller BS, Bedi A. Comparison of inside-out and
all-inside techniques for the repair of isolated meniscal tears: a sys-
The overall failure rate after all-inside meniscal repair of tematic review. Am J Sports Med. 2012;40(2):459-468.
20. Haas AL, Schepsis AA, Hornstein J, Edgar CM. Meniscal repair using
BHMTs is 29.3% at an average of 13.0 months, with no dif-
the FasT-Fix all-inside meniscal repair device. Arthroscopy. 2005;
ference in failure rates between medial and lateral menis- 21(2):167-175.
cal repairs. The repair failure rate for devices still in use is 21. Harris B, Miller MD. Biomedical devices in meniscal repair. Sports
19.0%. The variables shown to negatively affect the failure Med Arthrosc Rev. 2006;14(3):120-128.
rates were the RapidLoc device and the Biofix Arrow, male 22. Jones HP, Lemos MJ, Wilk RM, Smiley PM, Gutierrez R, Schepsis
sex, and longer follow-up duration. AA. Two-year follow-up of meniscal repair using a bioabsorbable
arrow. Arthroscopy. 2002;18(1):64-69.
23. Kise NJ, Drogset JO, Ekeland A, Sivertsen EA, Heir S. All-inside
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