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Taking Aim: Arrows Replace Stitches for Meniscal Repair

The meniscus, or knee cartilage, is commonly torn in athletic injuries. Often, one of the ligaments inside the knee is torn along with it. Ten years ago, this kind of injury would have resulted in surgical removal of part or all of the meniscus. Now, improved methods are available to hold the meniscus in place. Sutures or stitches are being replaced by devices called arrows. These fasteners have barbed shafts that help hold the knee cartilage together.

There are many advantages to these arrows. They are bioabsorbable, which means the body absorbs or dissolves the material once the area has firmly healed. Operating time is cut in half because of the ease of inserting the arrows. And there are fewer cases of additional operations or serious complications with arrows.

Possible problems include arrows moving or sticking out of the skin, arrow breakage, and symptoms at the repair site. There may also be knee pain or tenderness, skin irritation, and bruising under the skin.

When a new technique is introduced in the world of orthopedic surgery, it takes a while to decide who can and can't have that procedure. For example, certain types of tears don't heal well with arrows. Irritation of the skin and knee pain or tenderness occur in one-third of all patients. However, these symptoms usually go away in the first year.

More and more people are choosing to repair a torn meniscus rather than remove it. This is partly because of the improved equipment used in surgery. One-third of all meniscal repairs are performed with the new bioabsorbable arrows. Doctors continue to look for ways to improve the design and use of arrows. The size of arrows and the location and angle of arrow insertion are all under careful study.

References: Hugh P. Jones, MD, et al. Two-Year Follow-up of Meniscal Repair Using a Bioabsorbable Arrow. In Arthroscopy. January 2002. Vol. 18. No. 1. Pp. 64-69.

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