All-inside meniscal repair using polyether ether ketone versus all-suture anchors: No difference in failure rates at three-follow-up in a retrospective cohort of 2253 patients.

Purpose: To compare mid-term failure rates of next-generation all-inside meniscal repair using polyether ether ketone (PEEK) anchors versus all-suture anchors in a large patient cohort. The null hypothesis was that there would be no difference in failure rates between PEEK and all-suture anchors.

Methods: A retrospective cohort study was conducted on all consecutive patients who underwent arthroscopic all-inside meniscal repair between January 2015 and June 2022 at Capio Artro Clinic, Stockholm, Sweden. Patients were included if they had isolated or anterior cruciate ligament reconstruction (ACLR) associated medial or lateral meniscal repairs using either PEEK or all-suture devices. Revision meniscal repairs were excluded to ensure a homogeneous cohort. The primary outcome was failure of meniscal repair, defined as reoperation with partial or total meniscectomy or re-suture within 3 years. Logistic regression was used to identify predictors of failure. Between-group comparisons were performed using chi-square and t-tests.

Results: Of the total cohort of 2253 patients, 271 patients received all-suture anchors and 1982 received PEEK anchors. The overall reoperation rate was 17.3% (47/271) in the all-suture group and 20.7% (410/1982) in the PEEK group, with no statistically significant difference. Subgroup analysis by laterality (medial [21.5%, 28/271] vs. lateral meniscus repair [27.1%, 324/1982]), or isolated repair versus ACLR with repair did not reveal significant differences in failure rates for the different devices. Logistic regression further revealed that isolated meniscal repair (odds ratio [OR]: 3.01; 95% confidence Interval [CI]: 2.41-3.76; p < 0.001), female gender (OR: 1.30, 95% CI: 1.05-1.61; p = 0.017), and medial meniscus repair (OR: 2.89; 95% CI: 2.27-3.69; p < 0.001) were significant predictors of meniscal repair failure.

Conclusion: All-suture and PEEK-based all-inside meniscal repair devices demonstrated comparable failure rates within 3 years. Device type was not associated with increased risk of failure, whereas isolated repair, medial meniscal repair, and female gender were significant predictors. These findings support the clinical effectiveness of both anchor types, allowing device selection to be based on surgeon preference and tear characteristics rather than concerns over differential failure risk.

Level of evidence: Level III, retrospective cohort study.