Subcutaneous migration of meniscal arrows after failed meniscus repair - Areport of two cases

The Biofix absorbable Meniscal Arrow (BIONX Implants, Ltd., Tampere, Finlan d) has become an acceptable alternative to meniscal suture because of its e ase of use and lower risk of neural and vascular complications.' The arrow is a T-shaped fastener with a barbed shaft and a sharply pointed apex. It i s available in 10-, 13-, and 16-mm lengths, recommended for the anterior, m iddle, and posterior thirds of the meniscus, respectively. This polylactic acid arrow remains structurally intact for approximately 6 months and takes up to 3 years to fully resorb. There has been a recent report of four case s of transient posterior knee pain with the Meniscal Arrow.(5) We report on two patients with more significant symptoms that did not resolve spontaneo usly but necessitated removal of the arrows. Since the beginning of 1997, we have used the Biofix Meniscal Arrow system at our institution in 38 cases. A total of 114 arrows were inserted in thes e 38 patients. All of these cases were bucket-handle tears of the medial an d lateral menisci. The patient selection for this procedure has been conser vative, with only peripheral red-on-red or red-on-white tears in young pati ents being treated. In euo instances, patients developed nontransient knee pain related to the Meniscal Arrows. In both cases the meniscus repair fail ed. Failure of meniscus repair is not uncommon.(5) One study reported failu re in greater than 20% of cases (4 of 19) in which the Meniscal Arrow was u sed.(4)