Blade Fracture of High-Speed Meniscus Cutters during Arthroscopic Surgery
Hazard [Health Devices Sep 1991;20(9):361-2]
In 1990, we received three reports from three different member hospitals regarding incidents in which the
blade of a high-speed, power-driven arthroscopic meniscus cutter broke during knee surgery,
depositing metal shavings in the operative site. In each case, the broken meniscus cutter
was manufactured by a different company. The blade pieces were successfully removed from the
patient in only one of these three incidents. Further review of ECRI's and U.S.
Food and Drug Administration (FDA) databases yielded several dozen complaints about the presence
of metallic fragments in the operative field following the use of these cutters during
The presence of even small metallic fragments within the body can result
in an infection of either surgical or hematogenous origin. Bacteria that become engrafted
on a foreign metallic surface in the body usually respond poorly to antibiotic medication,
and arthrotomy is often required to remove the metallic bodies and any infected tissue.
Moreover, because these meniscus cutters, which are powered by high-speed drive systems,
can rotate at speeds in excess of 3,000 rpm, broken pieces of metal from the cutter's
blade can become impacted in the surrounding tissues and cause serious injury.
High-speed, power-driven meniscus cutters, available in both single-use
and reusable models, were developed to reduce the amount of time necessary to resect
tissue and cartilage during arthroscopic surgery. They have an inner shell surrounded by
an outer sheath. The inner shell is a long, hollow, cylindrical shaft to which a cutting
head is joined.
outer sheath contains an opening at its distal end through which the
inner shell's cutting head operates (see figure).
Cutting efficiency is directly related to the gap separating the inner shell's cutting
head from the inside edge of the outer sheath. Reducing the distance separating these two
cutting surfaces increases cutting performance; however, if this gap is reduced to the
degree that the blade's rotating cutting surface is unable to spin freely, an amount of
heat sufficient to cause blade failure may be produced.
Three main factors can cause the blades of meniscus cutters to break: 1)
If either the inner shell or the outer sheath of the cutter becomes bent by the large
cantilever forces encountered during surgery, the blade's two cutting surfaces may rub
against each other, resulting in wear or breakage. 2) The cutter's inner shell is
constructed of two pieces, which may become misaligned during manufacturing; this can
cause either piece to scrape against the cutter's outer sheath, which can result in blade
fracture. In addition, stresses produced during arthroscopic surgery may become
concentrated at the seam where the two pieces join, further increasing the probability of
blade breakage. 3) Either piece of the cutter's inner shell may be coated with a metallic
compound to increase surface hardness, and excessive abrasion between the blade's two
cutting surfaces may cause fragments of this metallic coating to shed into the operative
Several manufacturers of high-speed, power-driven meniscus cutters are
modifying the blade design to reduce the likelihood of blade wear and breakage. Some
modifications include manufacturing the blade's cutting head with very strong,
wear-resistant stainless steel; increasing the thickness of the inner shell; or hardening
- Be sure that the orthopedic surgeons in your
institution who use high-speed, power-driven meniscus cutters are aware of
the potential for blade wear and breakage.
- Do not reuse single-use blades.
- Examine the operative field for the presence of
metallic materials before closure.
- Inspect the blade for damage or wear, which may indicate that metallic
fragments or particles are present in the operative site. If you suspect or
detect any such fragments or residue, thoroughly irrigate the joint and
apply suction as required. In some instances, an x-ray of the joint may be
necessary to pinpoint the exact location of the fragments.
- Burs, Orthopedic [17-995]
- Cutters, Meniscus [17-117]
- Knives, Meniscus [12-248]
Cause of Device-Related Incident
Device factor: Design/labeling error
Mechanism of Injury or Death