Smith & Nephew Fast-Fix 360 Curved
Smith & Nephew Fast-Fix 360 Curved
Smith & Nephew Fast-Fix 360 Curved
KNEE
HIP
SHOULDER
EXTREMITIES
PRELIMINARY - NOT FOR DISTRIBUTION
The meniscus contributes to optimal knee joint function because of its critical role in: Prepared in Consultation with:
Charles H. Brown, Jr., MD
Load transmission Shock absorption
Medical Director
Joint stability Lubrication Abu Dhabi Knee & Sports Medicine Centre
Articular cartilage nutrition Neuromuscular proprioception Abu Dhabi, United Arab Emirates
Clinical studies have demonstrated that even partial meniscectomy can lead to
early joint chondrosis and arthrosis.1 As a result, repair of peripheral and red/white Nicholas Sgaglione, MD
Associate Chairman and Program Director
meniscal tears is now the standard of care.
Department of Orthopaedic Surgery
North Shore-Long Island Jewish Medical Center
Inside-Out Repair New Hyde Park, New York
Due to the ability to predictably place vertical or horizontal mattress sutures on
the femoral or tibial surfaces of the meniscus, the inside-out repair technique
is considered by many surgeons to be the gold standard for meniscal repair.
Technique requires a posterior incision and dissection to avoid neurovascular
complications, thereby adding morbidity and operative time to the procedure.
Technique requires a trained assistant to retrieve and tie the repair sutures.
Outside-In Repair
The outside-in repair technique was introduced in an attempt to eliminate the
need for a posterior incision and dissection.
Technique offers limited access to tears in the posterior third of the meniscus.
Limits the surgeons ability to perform a vertical mattress suture and place sutures
on the tibial surface of the meniscus.
All-Inside Repair
The all-inside arthroscopic suture-based technique addresses many of
the limitations of the inside-out and outside-in techniques. This technique has
gained popularity because of the following advantages:
The repair can be safely performed without a posterior incision.
The technique allows easy access to tears in the posterior and
middle thirds of the meniscus.
The repair can be performed without a trained assistant.
The technique allows vertical or horizontal mattress sutures to be inserted
on the femoral or tibial surface of the meniscus.
These advantages allow for minimally invasive meniscal repair, resulting in less
postoperative pain and morbidity for patients.2
Overview
The FAST-FIX 360 Meniscal Repair System provides a strong, reproducible, and time-saving technique for meniscal repair.
Biomechanical studies have demonstrated that a vertical mattress suture performed using the FAST-FIX 360 Meniscal Repair
System has biomechanical properties equal to that of a vertical mattress suture performed using the open and inside-out
repair techniques.
Building on the proven clinical success of the earlier FAST-FIX and ULTRA FAST-FIX Meniscal Repair Systems techniques,
the all new FAST-FIX 360 Meniscal Repair System offers the following advantages:
Versatility to place horizontal or vertical mattress sutures on the femoral or tibial surfaces of the meniscus.
Easier and faster implant deployment with added safety features:
Implants are pushed out of the delivery needle rather than being stripped away from the needle.
Minimizes the depth of needle penetration needed to successfully deploy the implants
Decreased risk of injury to nearby neurovascular structures
Smaller insertion points, minimizing disruption to the meniscus
A built-in depth penetration limiter
Stiffer needle shaft for enhanced delivery control
Ability to reposition the needle for optimal suture placement
As a result, the FAST-FIX 360 meniscal Repair System (Figure 1) helps optimize the chances of a successful repair.
Auditory confirmation
Enhanced suture
management Laser-marked
needle tip
360 active deployment slider
Stiffer, low-profile needle shaft
Procedure
The FAST-FIX 360 devices are manufactured with straight or curved
delivery needles. The delivery needles are not intended to be bent by
the user. The intentional bending of the delivery needle may make it
difficult or impossible to deliver the T1 and T2 implants. If the delivery
needle has been bent inadvertently, or if resistance is encountered
during deployment, a new delivery device may be needed.
As with all arthroscopic procedures, adequate joint distention
and visualization of the meniscus tear are essential for success.
To minimize the potential for damage to neurovascular structures,
it is strongly recommended that the surgeon use the built-in,
Figure 3. Establish depth limit using the adjustable depth limiter adjustable depth penetration limiter to control the depth of
and depth probe.
penetration of the delivery needle.
Meniscal tear site preparation is essential for biological healing of
the tear. Meniscal rasps and/or arthroscopic shavers are used to
abrade and excoriate both sides of the tear and the perimeniscal
synovium. Once the optimal portal placement is determined and
the meniscal tear site is prepared, perform the repair as follows:
1. Use the meniscal depth probe to determine the desired depth
limit. Place the tip of the probe at the meniscosynovial junction
and determine the width of the meniscus at the desired entry
point for the delivery needle. In the average size knee, a depth
of 14 mm is usually adequate. Adjust the depth penetration
limiter to the desired length by pressing the depth limiter button
Figure 4. Use laser marks as a reference. (Figure 3). This length can be adjusted outside or inside of the
joint. The laser marks on the tip of the needle can also be used
as a reference (Figure 4).
2.Insert the FAST-FIX 360 delivery needle into the joint through the
appropriate arthroscopic portal. Insertion is facilitated through the
use of the slotted cannula (sold separately) (Figure 5).
Figure 6. Introduce the delivery needle into the joint with the tip
down against the slotted cannula.
Figure 5. Use a slotted cannula to ease insertion.
The slotted cannula eases passage through the fat pad, and the
cannula can also be used to help position the tip of the delivery
needle at the desired location on the meniscus. Introduce the delivery
needle through the slotted cannula into the joint, ensuring that the tip
of the needle is pointing down (Figure 6). Once the needle is inside
the joint, the slotted cannula may be removed if desired.
Pearl: Hold the delivery needle at the handle and push the
slider with the thumb to deploy the implants. Do not advance the
deployment slider while introducing the delivery needle into the
joint or the implant will deploy prematurely.
Figure 7. Insert the delivery needle into the meniscus through Figure 8. Keep the delivery needle in position during deployment
the capsule. of the implants.
Figure 9. Push the deployment slider all the way forward Figure 10. Withdraw the delivery needle from the meniscus slowly
to deploy T1. for better suture management.
Position the slotted cannula at the desired entry point on the inner
meniscal fragment (if desired). The entry point for the second (T2)
implant should be at least 5 mm from the tear site. Advance the
delivery nee dle until the depth penetration limiter contacts the
surface of the meniscus (Figure 12). Keeping the delivery needle
in position, push the deployment slider all the way forward to deploy
T2 (Figure 13). As with T1, proper deployment of T2 is accompanied
by a clicking sound. Slowly withdraw the delivery needle from the
joint after deployment of T2 (Figure 14).
Pearl: Do not push the deployment slider until the needle is fully
Figure 12. Advance the delivery needle to the preset needle depth limit.
penetrated through the meniscus to the preset depth limit or T2
will deploy prematurely.
Figure 16. Apply tension to the suture to cinch the knot down.
8 K N E E TEC HN I Q U E G UI D E 10600542 Rev. B
PRELIMINARY - NOT FOR DISTRIBUTION
Figure 17. Slide the knot pusher/suture cutter to the knot. Figure 18. Push the knot pusher/suture cutter tip against the knot
to recess the knot.
Figure 19. Push the trigger to cut the suture. Figure 20. Completed vertical mattress stitch.
6. T o further tighten the knot and further compress the tear site,
thread the free end of the suture through the knot pusher/suture
cutter. Both curved and straight knot pushers/suture cutters are
available. Use a suture funnel to facilitate threading of the suture.
7. While holding the suture taut, gently slide the knot pusher/suture
cutter to the knot (Figure 17). The knot pusher should engage the
suture in a direct line perpendicular to the repair. A manual suture
pull/push maneuver is suggested, and the knot should be
tightened until the desired amount of compression is generated at
the tear site.
8. Position the tip of the knot pusher/suture cutter against the knot
to ensure a 23 mm suture tail when the suture is cut. Continuing
to hold the suture taut, push the knot pusher/suture cutter tip
against the knot. In some cases it is possible to recess the knot
into the surface of the meniscus, leaving the tail of the suture
flush with the surface of the meniscus (Figure 18). Cut the suture
by pushing the trigger forward (Figures 19 and 20). Because of
the high strength of the suture, using a small arthroscopic basket
punch or scissors to cut the suture often results in the tail of the
suture being frayed.
9. P
lace sutures on the tibial side of the tear as well as the femoral
side of the tear to reduce puckering of the meniscus. The reverse
curved delivery needle is especially useful for placing sutures on
the tibial side of the tear.
Technique Pearls
Choose the portal which most easily allows the delivery needle to be inserted perpendicular to the tear site.
User-initiated bending of the device needle may result in implant non-deployment. If resistance to deploy an implant
is encountered, or if needle bending is observed during use, a new delivery device may be needed.
Vertical mattress suture: T1 inserted into the capsular side of the tear; T2 inserted on the meniscal side of the tear.
The pre-tied, self-sliding knot included in the FAST-FIX 360 Meniscal Repair System slides from (T1) to (T2). Therefore,
placing T1 further away than T2 facilitates sliding of the knot.
Hold the device at the handle and push the slider with the thumb to deploy T1 and T2.
Release slider after deployment of T1 to allow spring back of the slider to pick up T2.
For better suture management and to prevent pulling out T2, release the deployment slider and slowly draw the needle
out of the meniscus while maintaining the needle tip within the arthroscopic view at all times.
If the knot does not cinch smoothly, it usually requires a steady and more forceful pull, which is facilitated by wrapping
the suture around several fingers, like a pulley, and applying tension.
Avoid over-cinching the knot, which can result in puckering of the meniscus or the suture cutting through the meniscus
and weakening the repair.
Alternate divergent femoral side and tibial (tensile) side suture placement optimizes the strength of the repair and helps
achieve an anatomic repair.
Consider the reverse-curved delivery needle for placing sutures on the tibial surface of the meniscus.
Place the FAST-FIX 360 delivery needle either through the inferior (tibial) or superior (femoral) surface of the meniscus
for optimal strength.
For the easiest knot sliding and avoidance of the neurovascular bundles, insert the needle perpendicular to the tear using
a contralateral approach. Use portals placed adjacent to the patella tendon to facilitate this procedure.
Postoperative Care
The FAST-FIX 360 Meniscal Repair System utilizes a high strength non-absorbable suture and allows the repair to
be performed with a vertical mattress suture, which has been shown to be the strongest meniscal repair technique.
As a result, the standard rehabilitation protocol used with inside-out repairs can be followed.
Additional Instruction
Prior to performing this technique, consult the Instructions for Use documentation provided with individual components
including indications, contraindications, warnings, cautions, and instructions.
REFERENCES
1. Ak. Joy Singh, Nilachandra L, Y. Nandabir Singh, Brogen Ak. Rehabilitation Following
Arthroscopic Partial Meniscectomy - A Neglected Issue. IJPMR 15, April 2004: 1-6.
2. Sgaglione, Nicholas A. Meniscus Repair: Update on New Techniques. Techniques in
Knee Surgery 1(2) December 2002: 113-127.
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PRELIMINARY - NOT FOR DISTRIBUTION
Ordering Information
To order the instruments used in this technique guide, call +1 800 343 5717 in the U.S. or contact an authorized
Smith & Nephew representative.
Prior to performing this technique, consult the Instructions for Use documentation provided with individual
components including indications, contraindications, warnings, cautions, and instructions.
CAUTION: U.S. Federal law restricts these devices to sale by or on the order
of a physician.
Endoscopy
Smith & Nephew, Inc. www.smith-nephew.com
Courtesy of Smith & Nephew, Inc., Endoscopy Division
150 Minuteman Road +1 978 749 1000
Andover, MA 01810 +1 978 749 1108 Fax Trademark of Smith & Nephew. Registered U.S. Patent & Trademark Office.
USA +1 800 343 5717 U.S. Customer Service 2012 Smith & Nephew, Inc. All rights reserved. 10/2012 10600542 Rev. B