The fixation of meniscal tears has undergone a revolution since the introduction of fixators into arthroscopic surgery a decade ago. The simplicity and ease of insertion of these devices led to their popularity for the repair of torn menisci. The only alternative was the traditional suture technique, which required additional incisions, prolonged operative time, and the risk of neurovascular injury.

The first fixators on the market were somewhat rigid devices made of a variety of bioabsorbable materials, with varying resorption times. They are supplied in varying lengths, with the appropriate size chosen depending on the location of the tear. They were designed with barbs, heads, or screw threads to engage meniscal tissue, and therefore are not well suited for the most peripheral tears or capsular detachments. Compression at the tear site is often difficult to achieve and nearly impossible to adjust after insertion. Among the most popular first-generation fixators are the Arrow, the Hornet, the Clearfix Screw, and the Dart.

With increasing reports of unsatisfactory long-term results and the inability to repair peripheral tears to the capsule, a second generation of meniscal fixators was developed to more closely mimic suture repairs. The two suture-based implants currently available are the Fast-Fix (Smith & Nephew, Endoscopy Division, Andover, MA) and the RAPIDLOC (Mitek Surgical Products, Westwood, MA) (Fig. 9-1 A,B). Both of these implants consist of two small polymer T-bar anchors connected by a pre-tied, locking, sliding knot, which has eliminated the need for arthroscopic knot tying. Both Fast-Fix anchors and one of the RAPIDLOC anchors are designed to be deployed across the capsule, then rotate to engage the capsule when the connecting suture is pulled, analogous to EndoButton (Smith & Nephew, Andover, MA) fixation. Since the suture length between the two anchors adjusts during implantation to allow compression of the tear, these fixators come in only one size. The only variability is the angle of the needle delivery system. But, like other fixators, the anchors deployed across the capsule cannot be removed arthroscopically once inserted.

The Fast-Fix Delivery Needle is supplied with three angles: 0, +22, and −22 degrees (Fig. 9-1D). The −22-degree needle allows suture placement on the undersurface of the meniscus. The device requires that each anchor be deployed across the capsule, and at least one also pass through the tear. This allows for a vertical or horizontal suture orientation. The Rapid-Loc comes with needle tips of 0, 12, and 27 degrees (Fig. 9-1C). It is designed to be placed on the superior surface of the meniscus. Its insertion requires only one pass of the “backstop” anchor across the tear and through the capsule. Both fixators come with anchors and sutures that are permanent or bioabsorbable. The choice depends on surgeon preference. I prefer permanent material, as is my choice when doing the traditional inside-out or outside-in suture repair techniques.