Fast fix

Manufactured by Smith & Nephew

Sourced in United Kingdom, United States

Fast-Fix is a minimally invasive surgical device designed for tissue repair. It provides a secure and consistent method for attaching soft tissues to bone.

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Lab products found in correlation

Acl tightrope, by Arthrex (1 mentions) Meniscal cinch, by Arthrex (1 mentions) Fiberwire, by Arthrex (1 mentions) Orthocord suture, by DePuy (1 mentions) Tightrope, by Arthrex (1 mentions) Endobutton cl ultra, by Smith & Nephew (1 mentions)

13 protocols using fast fix

Anterior Cruciate Ligament and Meniscus Repair

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For ACLR, we used a proximal extra-cortical fixation (Endobutton CL Ultra, Smith&Nephew, London, UK) and a tibial hybrid fixation using a bioresorbable interference screw and additionally extra-cortical fixation with the femoral tunnel drilled via the anteromedial portal.
The meniscal repairs were performed as follows: posterior horn repairs were performed using an all-inside technique (FastFix, Smith&Nephew, London, UK), the anterior lesion was repaired using an outside-in technique and the three root tears were arthroscopically reconstructed via an additional transtibial drilling with extracortical button fixation (Endobutton CL Ultra, Smith&Nephew, London, UK). Repairs of bucket-handle lesions were performed combining all-inside techniques (FastFix, Smith&Nephew, London, UK), and inside-out techniques using non-resorbable sutures (PDS 2-0).

Wenning M., Heitner A.H., Mauch M., Gehring D., Ramsenthaler C, & Paul J. (2020). The effect of meniscal repair on strength deficits 6 months after ACL reconstruction. Archives of Orthopaedic and Trauma Surgery, 140(6), 751-760.

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Meniscal Repair Techniques in Surgery

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All surgeries were performed by the three senior authors (H.N., S.Y., M.Y.) under general anesthesia. We used a tourniquet for all cases. The inside-out technique was primarily used as the repair technique,¹⁰ (link) while the outside-in technique and the all-inside technique utilizing Fast-Fix (Smith & Nephew) were used alone or in conjunction with inside-out repair. A fibrin clot¹¹ was inserted and fixed to the capsule neighboring the repair site to enhance the meniscal healing in case of degenerative tears and tears in poorly vascularized region.

Nakayama H., Kanto R., Kambara S., Kurosaka K., Onishi S., Yoshiya S, & Yamaguchi M. (2017). Clinical outcome of meniscus repair for isolated meniscus tear in athletes. Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology, 10, 4-7.

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Anatomic ACL Reconstruction with Autograft

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Arthroscopic ACL-R was performed in single-bundle technique with an autologous hamstring graft (semitendinosus ± gracilis tendon) and anatomic femoral and tibial tunnel placement. The femoral tunnel was drilled via an anteromedial portal according to the diameter of the ACL autograft. A cortical suspension device (ACL TightRope, Arthrex, Naples, USA) was used for femoral graft fixation and a bio-absorbable interference screw (Arthrex, Naples, USA) was used for tibial fixation. Concomitant meniscus lesions were treated by either all-inside meniscus suture devices (Fast-Fix, Smith&Nephew, London, UK) or inside-out technique.

Lutz P.M., Achtnich A., Schütte V., Woertler K., Imhoff A.B, & Willinger L. (2021). Anterior cruciate ligament autograft maturation on sequential postoperative MRI is not correlated with clinical outcome and anterior knee stability. Knee Surgery, Sports Traumatology, Arthroscopy, 30(10), 3258-3267.

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Arthroscopic Meniscal Repair Techniques

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We used curved and straight suture Lasso (Biomet), Suture Passer (Arthrex), FasT-Fix (Smith and Nephew), Meniscal Cinch (Arthrex), MaxFire (Biomet), and sometimes a straight Cannula. We used non-absorbable sutures such as Maxbraid suture (Zimmer Biomet), Fiberwire (Arthrex), and Orthocord suture (Depuy mitek).

Abdel Tawab Abdallah M., Said H.G., Ramadan E.K., Abd El-Radi M, & El-Assal M.A. (2020). Results of meniscal injuries repair using different arthroscopic techniques. SICOT-J, 6, 39.

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Arthroscopic Meniscal Repair Techniques

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All participants in this study underwent arthroscopic meniscal repair surgery. A traditional two-portal approach was utilized. Three common suturing techniques were employed for meniscus repair, chosen based on the tear’s location and type, in order to provide optimal fixation and adaptability. The sutures were made either all-inside with internal anchors (Fast-Fix, Smith & Nephew) or inside–outside (Meniscus Needles, Arthrex) or outside–inside with a 2–0 number fiberwire suture and needles. No extra incisions were made if only the all-inside technique was used. Additional incisions between sutures on the skin were created in cases where either inside–outside or outside–inside techniques, or both, were performed. The sutures were orientated in various ways depending on the tear pattern, with the goal of aligning them vertically to enhance fixing strength. Table 1 shows the distribution of suturing methods and the number of sutures.

Martinkėnienė V.B., Austys D., Šaikus A., Brazaitis A., Bernotavičius G., Makulavičius A., Sveikata T, & Verkauskas G. (2024). Do MRI Results Represent Functional Outcomes Following Arthroscopic Repair of an Isolated Meniscus Tear in Young Patients?—A Prospective Comparative Cohort Study. Clinics and Practice, 14(2), 602-613.

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Arthroscopic Meniscus Repair Surgical Protocol

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All patients underwent arthroscopic surgery for BHMT in one department by experienced orthopaedic knee surgeons as also previously described [26 (link)]. A tourniquet was used at 280mmHg and Cefuroxim 1.5 g was administered as perioperative prophylaxis. A routine diagnostic assessment of the intraarticular structures was performed with a 30° arthroscope. The torn meniscus was repaired using either all-inside (AI, Fast-Fix, Smith & Nephew, Andover, MA, USA) or sutures in inside-out (IO) technique depending on tear location. Sutures were placed every 5 mm to provide reliable repair strength. Non-absorbable Fiberwire sutures (Arthrex Inc, Naples, Florida, USA) were used for inside-out technique. In case of concomitant ACL rupture a reconstruction with ipsilateral semitendinosus tendon was performed. A suspension bridge fixation (TightRope®, Arthrex Inc, Naples, Florida, USA) was used femoral fixation and an interference screw tibially.
For postoperative management, all patients had their operated leg secured in a brace for 6 weeks. ROM was restricted to either 90° or 60° of flexion after medial meniscus and lateral meniscus repair, respectively. In the case of medial meniscus repair, weight bearing was only allowed in full extension, after lateral meniscus repair weight bearing was prohibited for 6 weeks. Patients received physiotherapy at a minimum of two times a week.

Muench L.N., Achtnich A., Krivec L., Diermeier T., Woertler K., Braun S., Imhoff A.B, & Willinger L. (2022). Clinical outcome and healing rate after meniscal bucket handle tear repair. BMC Musculoskeletal Disorders, 23, 1063.

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Arthroscopic Meniscal Allograft Transplantation

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All procedures were performed utilizing a minimally invasive arthroscopic technique with soft tissue fixation through bone tunnels. The technique has previously been described in detail by Spalding et al.^{17 (link)} Menisci were sized according to radiographic measurements, and nonirradiated fresh frozen allografts were obtained from 1 of 3 tissue banks: NHSBT UK, RTI, and JRF Ortho. After preparation of the meniscal rim, 4.2-mm drill holes were created from the anterolateral or anteromedial tibial surface, emerging in the anatomic insertion sites of the meniscal roots. Lead sutures were passed and the transplant graft fed into the knee, tying the posterior and anterior horn sutures over a bone bridge on the tibia. Peripheral meniscal fixation was achieved using a combination of fixation devices (FastFix; Smith & Nephew) and inside-out sutures (2-0 Ticron; Covidien) tied over the capsule.

Parkinson B., Smith N., Asplin L., Thompson P, & Spalding T. (2016). Factors Predicting Meniscal Allograft Transplantation Failure. Orthopaedic Journal of Sports Medicine, 4(8), 2325967116663185.

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Lateral Meniscal Tear Evaluation and Repair

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We probed the presence and degree of the lateral meniscal tear during an arthroscopic survey before ACLR. Furthermore, we examined the morphology of the tear (ie, longitudinal, radial, and flap tears) and the lateral meniscal tear lesion (ie, posterior root, posterior horn, and middle body). Meniscal repair was performed if the torn lateral meniscal body was retracted easily by probing and the torn part of the meniscus did not contain any connected tissue (Figure 2, A and B). We repaired the meniscus when the tear occurred in a red-white or red-red zone because these zones are vascularized and have the potential to heal the injured meniscal tissue (Figure 2, C and D).^{2 (link),4 (link),45 (link)} However, if the lateral meniscal tear was connected by the remaining lateral meniscal tissue and the torn lateral meniscal tissue was stable by probing, we did not perform meniscal repair (Figure 2, E and F). Meniscectomy was performed on patients with a deteriorated torn meniscal body or a complex tear pattern (these patients were excluded from the study). Lateral meniscal repair was performed using a Fast-Fix (Smith+Nephew Endoscopy) or Knee Scorpion (Arthrex) system in accordance with the all-inside technique.

Chiba D., Yamamoto Y., Kimura Y., Sasaki E., Sasaki S., Tsuda E, & Ishibashi Y. (2024). Association Between MRI Signal Intensity of the Repaired Lateral Meniscus and Residual Anterolateral Knee Laxity After ACL Reconstruction. Orthopaedic Journal of Sports Medicine, 12(4), 23259671241241821.

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Meniscal Repair and Cartilage Debridement

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Suture repair (Fast-Fix; Smith & Nephew) and partial resection were undertaken for concomitant meniscal injuries, and debridement was conducted for cartilage damage with an International Cartilage Regeneration & Joint Preservation Society grade >2.

Karpinski K., Häner M., Bierke S., Diermeier T, & Petersen W. (2021). Comparing Knee Laxity After Anatomic Anterior Cruciate Ligament Reconstruction Using Quadriceps Tendon Versus Semitendinosus Tendon Graft. Orthopaedic Journal of Sports Medicine, 9(7), 23259671211014849.

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Surgical Techniques for ACL Reconstruction and Meniscal Repair

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ACL reconstruction was performed using bone patellar-tendon bone (BPTB)¹⁸ (link) or hamstring autograft by a single surgeon. When hamstring autograft was used, double bundle ACL reconstruction was performed.¹⁹ (link)
Management of meniscal injury was dictated by the location and morphology of the tear.²⁰ (link) Indication for meniscal repair was unstable tear (>15 mm in length) in the vascular zone. Meniscal repair was basically performed with inside-out technique. For relatively small longitudinal tear (10–15 mm in length), all-inside device (FasT-Fix, Smith and Nephew) was used. Stable longitudinal tear (<10 mm in length) was left in situ.

Tomihara T., Hashimoto Y., Takahashi S., Taniuchi M., Takigami J., Tsumoto S, & Shimada N. (2023). Analyses of associated factors with concomitant meniscal injury and irreparable meniscal tear at primary anterior cruciate ligament reconstruction in young patients. Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology, 32, 12-17.

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