Pitfalls associated with FasT-Fix meniscal repair

There are several devices currently available for all-inside meniscal repair. One of the newest of these devices, the FasT-Fix (Smith & Nephew, Endoscopic Division, Andover, MA), is attractive because it combines advantages of traditional inside-out meniscal repair with an all-inside technique. We chose to critically evaluate these devices in a cadaver model. FasT-Fix devices were inserted arthroscopically in 8 fresh-frozen cadaveric knees at 5 to 7 mm intervals. A total of 45 devices were placed (24 laterally, 21 medially), and the knees were subsequently dissected to determine the location of the inserted devices. Several potential pitfalls were identified during the evaluation. When using the depth penetration limiter that comes preset with the device (to a depth of 22 mm), superficial structures, including the iliotibial tract and even the skin, were at risk for penetration with the needle. The device could not effectively be inserted into the anterior meniscus or the extreme posterior horn. Other potential pitfalls seen during insertion of the FasT-Fix meniscal repair devices include suture tensioning issues (including failure of the suture during tightening), intra-articular deployment of the implants, premature deployment of both the first and second implants, difficulty in advancing the trigger for deployment of the second implant, and difficulty in placing vertical-mattress sutures. Although the FasT-Fix is already in clinical use, additional modifications would likely enhance meniscal repair using this device.