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-frozen cadaveric knees (age, 60 to 72 years) in relationship to the joint capsule, and adjacent neurovascular and musculotendinous structures. Five T-Fix devices were placed in the posterior meniscal regions at approximately 20 degrees intervals. Gross dissection enabled T-Fix bar and suture placement identification. Fifty total devices were placed (23 medially and 27 laterally). Lateral: None of the devices penetrated more superficially than the deepest capsular layer (layer III). Six of the 27 devices placed at the posterior horn of the lateral meniscus pierced the popliteus tendon. None of the bars pierced the lateral collateral ligament (layer III). All devices placed at the posterolateral knee were outside the arcuate ligament (layer III) but inside the fabellofibular ligament (layer II). Medial: Seven of the 23 devices pierced the deep medial collateral ligament (MCL, layer III), and 4 pierced the superficial MCL (layer II). Three devices pierced the sartorius 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 placed within the posterior meniscal horns had a greater than or equal to 1.5-cm buffer zone from the popliteal neurovascular bundle. Most bars (36 of 50) were anchored to the capsular layer (layer III) after piercing the meniscocapsular junction (layer II). T-Fix devices simulating arthroscopic all-inside meniscal repair provided well-positioned, solid suture anchorage through the junction with no neurovascular involvement. Care needs to be taken when placing lateral (popliteus muscle) and medial (gracilis, sartorius tendons and superficial MCL) devices to avoid possible soft tissue tenodesis.