An anatomic evaluation of T-Fix suture device placement for arthroscopic all-inside meniscal repair

This investigation documented the locations of endoscopically applied T-Fix suture devices (Acufex Microsurgical, Mansfield, MA) placed in six fresh-f rozen cadaveric knees (age, 60 to 72 years) in relationship to the joint ca psule, and adjacent neurovascular and musculotendinous structures. Five T-F ix devices were placed in the posterior meniscal regions at approximately 2 0 degrees intervals. Gross dissection enabled T-Fix bar and suture placemen t identification. Fifty total devices were placed (23 medially and 27 later ally). Lateral: None of the devices penetrated more superficially than the deepest capsular layer (layer III). Six of the 27 devices placed at the pos terior horn of the lateral meniscus pierced the popliteus tendon. None of t he bars pierced the lateral collateral ligament (layer III). All devices pl aced at the posterolateral knee were outside the arcuate ligament (layer II I) but inside the fabellofibular ligament (layer II). Medial: Seven of the 23 devices pierced the deep medial collateral ligament (MCL, layer III), an d 4 pierced the superficial MCL (layer II). Three devices pierced the sarto rius tendon (layer I) and one pierced the gracilis tendon (layer II). None of the medial devices created a plicating effect on the posterior capsule. None of the devices were placed near neurovascular structures. Devices plac ed within the posterior meniscal horns had a greater than or equal to 1.5-c m buffer zone from the popliteal neurovascular bundle. Most bars (36 of 50) were anchored to the capsular layer (layer III) after piercing the menisco capsular junction (layer II). T-Fix devices simulating arthroscopic all-ins ide meniscal repair provided well-positioned, solid suture anchorage throug h the junction with no neurovascular involvement. Care needs to be taken wh en placing lateral (popliteus muscle) and medial (gracilis, sartorius tendo ns and superficial MCL) devices to avoid possible soft tissue tenodesis.