Intraoperative Failure of Meniscus Fixation Devices After Range of Motion Cycling: A Survey of the Pediatric Research in Sports Medicine Society Membership

This is the authors' abstract. We don't add key points for this paper.

Background: Meniscal pathology often presents with concomitant anterior cruciate ligament (ACL) injury. During ACL reconstruction (ACLR), “cycling the knee” has been shown to help reduce graft creep after femoral fixation. Pullout of successfully deployed all-inside meniscal repair implants after knee “cycling” has been observed, but is sparsely documented in the setting of ACLR with concomitant meniscal pathology. Purpose: To investigate the frequency of and contributions to intraoperative meniscal repair failure during concurrent ACLR. Study Design: Cross-sectional study. Methods: A brief survey was distributed to members of the Pediatric Research in Sports Medicine Society. Participants met the inclusion criteria if they self-identified as orthopaedic surgeons who perform ACLR. The primary objective of the survey was to assess surgeons’ experience with meniscal implant failure and its relationship to practice patterns (ie, cycling the knee). Results: Of the 52 surveys distributed, 44 orthopaedic surgeons completed the survey after 3 months of data collection, representing a 84.6% response rate. The majority of participants reported treating patients primarily in the second or third decade of life. Participants unanimously reported they would address the meniscal pathology before performing the ACLR. Thirty-three (75%) participants reported cycling the knee before graft fixation. Nineteen (43.2%) respondents endorsed reinspection of the meniscus after ACL graft fixation, and among them, 7 (36.8%) reported at least 1 instance of meniscal implant failure. Meniscal implant failure was associated with fewer years in practice: surgeons who reported implant pullout had a median of 2 to 5 years in practice, while those who did not report implant pullout had a median of 5 to 10 years in practice ( P = .027). No other factors were associated with meniscal implant failure. The sample size was insufficient to analyze the possible association of implant failure with cycling alone or hyperflexion alone. Conclusion: Meniscal repair with concomitant ACLR is a common surgery for orthopaedic sports medicine specialists. Although these procedures often result in favorable outcomes, this study concludes that failure of meniscal implants does occur and may be more common early in practice. Therefore, further investigation into optimal procedural strategies to address meniscal tears in the setting of ACLR is necessary.