All-Inside, Inside-Out, and Outside-In Meniscus Repair Techniques and Outcomes

Abstract

The benefits of meniscus repair are clear when performed in the optimal patient population and tear characteristics. Fundamental principles of meniscus repair remain the same regardless of the fixation technique, including anatomic reduction, circumferential compression and biological stimulation. With the advancement of contemporary all-inside devices, all-inside techniques have gained significant popularity with their ease of use and shorter operative times without the need for an open exposure. The inside-out repair generally remains the gold standard for larger, more extensive or complex meniscus tears due to the greater versatility and allowing for more points of fixation with less iatrogenic damage to the meniscus. Both all-inside and inside-out techniques can be used for middle and posterior third zone meniscal tears. Outside-in repair techniques are generally reserved for the anterior one-third of the meniscus. High strength nonabsorbable braided suture or tape has become the standard for meniscus repair. Contemporary suture passing devices have been developed in more recent years, which may allow for the placement of circumferential compression sutures but with the potential downside of having intra-articular knot stacks on the meniscus. Although outcomes are generally positive, they will vary based on clinical factors including tear pattern, chronicity, tissue quality and knee stability. Complications may occur with each technique, but recurrent tearing or failure is the most common, even in the setting of optimal indications. Orthopaedic sports medicine surgeons should become proficient with a comprehensive armamentarium of meniscal repair techniques to optimize meniscus preservation, especially in younger patients.