Is the Use of Biodegradable Devices in the Operative Treatment of Avulsion Fractures of Fingers, the So-Called Mallet Finger Advantageous? A Feasibility Study with Meniscus Arrows®

Purpose: Treatment of Mallet fingers or fractures remains a controversial topic. No evident preference can be distilled from the reports of the clinical results obtained by conservative treatment with splints and internal fixation. If operative treatment is indicated, several techniques can be used. However, each technique has disadvantages like the risk of comminution of the fragment, the risk of infection and necrosis, a demanding operative technique and-or the necessity of removing the metallic devices. This can be avoided by the use of biodegradable devices. The purpose of this feasibility study was to evaluate the outcome of internal fixation of a Mallet fracture with a biodegradable device, the Meniscus Arrow®. Methods: We treated nine consecutive patients with a Mallet fracture by fixation of the fragment with a biodegradable Meniscus Arrow®, at this moment the smallest device available, with an average operation time of 14 minutes. Results: Postoperatively, no complications were found. All patients were satisfied by the results after surgery, with a restored range of motion in the distal interphalangeal joint as previously and good alignment with full consolidation of all fractures at radiological evaluation. Conclusions: The operative treatment of bony mallet fingers with the Meniscus Arrow® is a fast procedure without complications in our prospective series of nine patients and without the need of a second operation to remove the implant.

Deteriorating Outcomes after Meniscal Repair Using the Meniscus Arrow in Knees Undergoing Concurrent Anterior Cruciate Ligament Reconstruction

Background An increased awareness of the degenerative changes that occur in the knee after meniscectomy has led to efforts to salvage the injured meniscus. Numerous devices have been developed in an effort to provide the dual benefits of a durable meniscal repair and minimal invasiveness. Hypothesis The Meniscus Arrow is comparable to conventional inside-out suture repair in accomplishing long-term healing of meniscal tears. Study Design Case series; Level of evidence, 4. Methods This study is an extended follow-up of an original series of 32 patients withoutcomes analysis. All patients underwent meniscal repair with exclusive use of the arrow. All repairs were performed in the context of a concomitant anterior cruciate ligament reconstruction. Follow-up assessment included physical examination, arthrometry, the International Knee Documentation Committee instrument, and the Knee Disorders Subjective History visual analog scale. Intermediate follow-up at a mean of 2.3 years yielded a success rate of 90.6%. The mean follow-up in the present study has been extended to 6.6 years. Results The extended follow-up analysis revealed a substantial attrition in the success rate of this series of patients undergoing meniscal repair with the arrow. A 90.6% success rate at a mean follow-up of 2.3 years deteriorated to 71.4% at 6.6 years. Conclusion This study provides the longest follow-up in the literature of any of the all-inside meniscal repair implants. The Meniscus Arrow demonstrated long-term meniscal healing rates inferior to those found in the literature for inside-out suture repair techniques.