Prevalence, development, and factors associated with cyst formation after meniscal repair with the all-inside suture device

  • Shozaburo Terai
  • Yusuke HashimotoEmail author
  • Shinya Yamasaki
  • Shinji Takahashi
  • Nagakazu Shimada
  • Hiroaki Nakamura
Arthroscopy and Sports Medicine



To investigate the prevalence of cyst formation after using all-inside meniscal repair device and analysed the risk factors associated with it.


Between August 2008 and September 2013, 51 menisci of 46 patients were included in the study, 46 menisci of which had concomitant anterior cruciate ligament (ACL) ruptures and had an ACL reconstruction. Magnetic resonance imaging (MRI) of the knee was performed at 3, 6, 12 and 24 months after meniscal surgery. The MRIs were assessed to detect the development of cysts encasing the suture anchors and to evaluate meniscal healing. Statistical analysis was performed using multiple regression analysis.


Out of the 51 menisci examined, MRI revealed cysts in 15 menisci. Cysts were detected in 3 menisci at 6 months, in 9 menisci at 12 months, and in 3 menisci at 24 months after surgery. Only 3 patients (6.5%) were symptomatic, and cystectomy was performed in 2 of these patients and arthroscopic debridement in the other. Compared with using both the suture device and an inside-out suture repair, using the suture device alone was more likely to be associated with cyst development [odds ratio (OR), 12.04]. The medial meniscus was also significantly more likely to develop a cyst compared with the lateral meniscus (OR, 12.48). There was an increased outcome for the number of device use (P = 0.033). Though it was not statistically significant, the patients with anterior knee laxity (side-to-side difference > 3 mm using a knee arthrometer) were more likely to develop cysts than those without anterior knee laxity (P = 0.06). There were no significant differences between the remaining variables.


The prevalence of cyst formation around the suture implant was 29%, but most cases were not symptomatic. Significant risk factors for cyst formation included the use of a suture device alone, and a location in the medial meniscus.

Level of evidence



Meniscus Meniscal cyst FasT-Fix MRI 



Magnetic resonance imaging


Polyether ether ketone


Discoid lateral meniscus


Anterior cruciate ligament






International Knee Documentation Committee


Side-to-side difference


Odds ratio


Confidence interval



We thank Junsei Takigami M.D., Ph.D. from Shimada Hospital and Kazuya Nishino M.D. from Osaka City University for their technical support and data analysis.

Compliance with ethical standards

Conflict of interest

No authors declare any conflicts of interest relating to the submitted paper.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    McNicholas MJ, Rowley DI, McGurty D et al (2000) Total meniscectomy in adolescence. A thirty-year follow-up. J Bone Joint Surg Br 82:217–221. CrossRefGoogle Scholar
  2. 2.
    Henning CE (1983) Arthroscopic repair of meniscus tears. Orthopedics 6:1130–1132. CrossRefGoogle Scholar
  3. 3.
    Henning CE, Clark JR, Lynch MA et al (1988) Arthroscopic meniscus repair with a posterior incision. Instr Course Lect 37:209–221Google Scholar
  4. 4.
    Kelly M, MacNicol MF (2003) Identification of the saphenous nerve at arthroscopy. Arthroscopy 19:1–2. CrossRefGoogle Scholar
  5. 5.
    Espejo-Baena A, Golano P, Meschian S et al (2007) Complications in medial meniscus suture: a cadaveric study. Knee Surgery. Sport Traumatol Arthrosc 15:811–816. CrossRefGoogle Scholar
  6. 6.
    Dunaway DJ, Steensen RN, Wiand W, Dopirak RM (2005) The sartorial branch of the saphenous nerve: its anatomy at the joint line of the knee. Arthrosc J Arthrosc Relat Surg 21:547–551. CrossRefGoogle Scholar
  7. 7.
    Deutsch A, Wyzykowski RJ, Victoroff BN (1999) Evaluation of the anatomy of the common peroneal nerve. Am J Sports Med 27:10–15. CrossRefGoogle Scholar
  8. 8.
    Kim TK, Savino RM, McFarland EG, Cosgarea AJ (2002) Neurovascular complications of knee arthroscopy. Am J Sports Med 30:619–629. CrossRefGoogle Scholar
  9. 9.
    Morgan CD (1991) The ‘All-Inside’ meniscus repair. J Arthrosc Relat Surg 7(1):120–125CrossRefGoogle Scholar
  10. 10.
    Siebold R, Dehler C, Ellert T (2008) Prospective randomized comparison of double-bundle versus single-bundle anterior cruciate ligament reconstruction. Arthroscopy 24:137–145. CrossRefGoogle Scholar
  11. 11.
    Laprell H, Stein V, Petersen W (2002) Arthroscopic all-inside meniscus repair using a new refixation device: a prospective study. Arthroscopy 18:387–393. CrossRefGoogle Scholar
  12. 12.
    Walsh SP, Evans SL, O’Doherty DM, Barlow I (2001) Failure strengths of suture vs. biodegradable arrow and staple for meniscal repair: an in vitro study. Knee 8:151–156. CrossRefGoogle Scholar
  13. 13.
    Kocabey Y, Chang HC, Brand JC et al (2006) A biomechanical comparison of the FasT-Fix meniscal repair suture system and the rapidloc device in cadaver meniscus. Arthroscopy 22:406–413. CrossRefGoogle Scholar
  14. 14.
    Cohen SB, Boyd L, Miller MD (2007) Vascular risk associated with meniscal repair using Rapidloc versus FasT-Fix: comparison of two all-inside meniscal devices. J Knee Surg 20:235–240CrossRefGoogle Scholar
  15. 15.
    Kalliakmanis A, Zourntos S, Bousgas D, Nikolaou P (2008) Comparison of arthroscopic meniscal repair results using 3 different meniscal repair devices in anterior cruciate ligament reconstruction patients. Arthroscopy 24:810–816. CrossRefGoogle Scholar
  16. 16.
    Kocabey Y, Nyland J, Isbell WM, Caborn DNM (2004) Patient outcomes following T-Fix meniscal repair and a modifiable, progressive rehabilitation program, a retrospective study. Arch Orthop Trauma Surg 124:592–596. CrossRefGoogle Scholar
  17. 17.
    Albrecht-Olsen P, Kristensen G, Törmälä P (1993) Meniscus bucket-handle fixation with an absorbable Biofix tack: development of a new technique. Knee Surg Sports Traumatol Arthrosc 1:104–106CrossRefGoogle Scholar
  18. 18.
    Barber FA (2000) Articular cartilage damage, peripheral migration, and device failure as meniscal arrow complications: case report. Am J Knee Surg 13:234–236Google Scholar
  19. 19.
    Seil R, Rupp S, Dienst M et al (2000) Chondral lesions after arthroscopic meniscus repair using meniscus arrows. Arthroscopy 16:1–4. CrossRefGoogle Scholar
  20. 20.
    Choi N-H, Kim B-Y, Hwang Bo B-H, Victoroff BN (2014) Suture versus FasT-Fix all-inside meniscus repair at time of anterior cruciate ligament reconstruction. Arthroscopy 30:1280–1286. CrossRefGoogle Scholar
  21. 21.
    Hoffelner T, Resch H, Forstner R et al (2011) Arthroscopic all-inside meniscal repair-does the meniscus heal?: a clinical and radiological follow-up examination to verify meniscal healing using a 3-T MRI. Skeletal Radiol 40:181–187. CrossRefGoogle Scholar
  22. 22.
    Haas AL, Schepsis A, Hornstein J, Edgar CM (2005) Meniscal repair using the FasT-Fix all-inside meniscal repair device. Arthroscopy 21:167–175. CrossRefGoogle Scholar
  23. 23.
    Kotsovolos ES, Hantes ME, Mastrokalos DS et al (2006) Results of all-inside meniscal repair with the FasT-Fix meniscal repair system. Arthroscopy 22:3–9. CrossRefGoogle Scholar
  24. 24.
    Adachi N, Ochi M, Uchio Y et al (2004) Torn discoid lateral meniscus treated using partial central meniscectomy and suture of the peripheral tear. Arthroscopy 20:536–542. CrossRefGoogle Scholar
  25. 25.
    Stoller DW, Martin C, Crues JV et al (1987) Meniscal tears: pathologic correlation with MR imaging. Radiology 163:731–735. CrossRefGoogle Scholar
  26. 26.
    Kulkarni V, Mulford J (2012) Cyst following meniscal repair. Knee Surg Sports Traumatol Arthrosc 20:2197–2199. CrossRefGoogle Scholar
  27. 27.
    Rosso C, Müller S, Buckland DM et al (2014) All-inside meniscal repair devices compared with their matched inside-out vertical mattress suture repair: introducing 10,000 and 100,000 loading cycles. Am J Sports Med 0–8.
  28. 28.
    Dold AP, Swensen S, Strauss E, Alaia M (2017) The posteromedial corner of the knee. J Am Acad Orthop Surg 25:752–761. CrossRefGoogle Scholar
  29. 29.
    Hallén LG, Lindahl O (1966) the screw-home movement in the knee-joint. Acta Orthop. Google Scholar
  30. 30.
    Kim HY, Kim KJ, Yang DS et al (2015) Screw-home movement of the tibiofemoral joint during normal gait: three-dimensional analysis. Clin Orthop Surg 7:303. CrossRefGoogle Scholar
  31. 31.
    Thompson WO, Thaete FL, Fu FH, Dye SF (1991) Tibial meniscal dynamics using three-dimensional reconstruction of magnetic resonance images. Am J Sports Med 19:210–216. CrossRefGoogle Scholar
  32. 32.
    Hupperich A, Niemeyer GMSP, Eberbach MFH, Kühle NPSJ (2018) What are the factors to affect outcome and healing of meniscus bucket handle tears ? Arch Orthop Trauma Surg 138:1365–1373. CrossRefGoogle Scholar
  33. 33.
    Kijowski R, Rosas HG, Lee KL et al (2014) MRI characteristics of healed and unhealed peripheral vertical meniscal tears. Am J Roentgenol 202:585–592. CrossRefGoogle Scholar
  34. 34.
    Kang HJ, Chun CH, Kim SH, Kim KM (2012) A ganglion cyst generated by non-absorbable meniscal repair suture material. Orthop Traumatol Surg Res 98:608–612CrossRefGoogle Scholar
  35. 35.
    Kimura M, Hagiwara A, Hasegawa A (1993) Cyst of the medial meniscus after arthroscopic meniscal repair. Am J Sports Med 21:755–757. CrossRefGoogle Scholar
  36. 36.
    Lombardo S, Eberly V (2016) Meniscal cyst formation after All-Inside meniscal repair. Am J Sports Med 27(5):666–667CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Shozaburo Terai
    • 1
  • Yusuke Hashimoto
    • 2
    Email author
  • Shinya Yamasaki
    • 3
  • Shinji Takahashi
    • 2
  • Nagakazu Shimada
    • 4
  • Hiroaki Nakamura
    • 2
  1. 1.Department of Orthopaedic SurgeryOsaka City Juso HospitalOsaka-shiJapan
  2. 2.Department of Orthopaedic SurgeryOsaka City University Graduate School of MedicineOsaka-shiJapan
  3. 3.Department of Orthopaedic SurgeryOsaka City General HospitalOsaka-shiJapan
  4. 4.Department of Orthopaedic SurgeryShimada HospitalHabikino-shiJapan

Personalised recommendations