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On 29 april 2025, it was reported by an arthrex employee via email that for a total of 4 units of ar-4500, meniscal cinch, both implants failed to set.This was detected during an right knee meniscus repair surgery on (b)(6) 2025.The procedure was completed successfully with a total use of 8 units of ar-4500; 4 succeeded and 4 failed.There was no patient harm, and no secondary procedure needed.The knot pusher/cutter type is ar-4515.
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The complaint allegation was confirmed.One unpackaged ar-4500 meniscal cinch batch 15116180 was received for evaluation.Visual inspection revealed that both insertion spears were on the cannula, stuck together, with the handle of insertion spear #1 upside down, and the depth stop was far backward.This is an indication of incorrect surgical techniques.Both spear shafts were stuck at the depth stop.Functional testing was attempted by moving/sliding the insertion spears, but due to the damage, it was not possible to move them.The most likely cause of the reported and observed failure is user error, specifically improper surgical technique using the device.Directions for use (dfu) dfu-0156-6 all-inside meniscal repair devices.E.Warnings: 7.Pre-operative and operating procedures, including knowledge of surgical techniques and proper selection and placement of the device, are important considerations in the successful utilization of this device.The appropriate arthrex delivery system is required for proper implantation of the device.G.Precautions: 3.The depth stop should be used to avoid piercing structures peripheral to the capsule.4.Particular attention should be paid to excessive manually applied forces when deploying the device to avoid over-deployment.5.Do not bend the device cannula.6.Excessive movement of the device between deploying implant #1 and implant #2 can disrupt the deployment mechanism.7.In the event of unsuccessful implantation, the device(s) should only be retrieved under visual confirmation and if loose.Any attempt at retrieving devices entrapped in tissue or without visual confirmation of location may result in tissue damage or injury to the patient.8.Speedcinch, meniscal cinch ii and softstitch devices only: do not advance the implant beyond the tip of the cannula before penetrating the meniscus.9.Meniscal cinch device only: do not pull the trocar back into the cannula after it has been advanced as this could prematurely deploy the implant.10.Meniscal cinch device only: if resistance is felt during implant deployment, advance trocar to depth stop and rotate trocars back and forth with controlled pressure.This is to avoid damaging implants.11.Meniscal cinch device only: to avoid premature tension to construct do not pull external suture before releasing trocar #2.12.Meniscal cinch and softstitch devices only: do not trap external suture against handle.13.Meniscal cinch device only: after implanting #1, do not move device before releasing trocar #2.14.Softstitch device only: keep the pushrod in the implant delivery cannula when penetrating soft tissue.
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