Meniscal Repair Techniques

Abstract

Our knowledge and understanding of the menisci have evolved over time. Once thought to be vestigial structures, an increased awareness of the significance of the menisci has fostered an emphasis on meniscal preservation. The last three decades have witnessed the growth and evolution of several arthroscopic meniscal repair techniques, including the following: (1) inside-out repair, (2) outside-in repair, and (3) all-inside repair. Inside-out repair involves passage of the suture into the joint, across the meniscus, and ultimate retrieval through a carefully dissected counterincision. It is generally regarded as the gold standard for repair, and is best suited for middle and posterior third tears. Outside-in repair techniques were subsequently developed to decrease the chance of neurovascular injury. Most suited for anterior horn and middle third tears, the outside-in method relies on the percutaneous passage and retrieval of suture, with final fixation done via smaller counterincisions. Recently, all-inside (“all-arthroscopic”) methods using meniscal fixators are being used to their ease of application, decreased operative times, and even lower risk to neurovascular structures. These fixators range from rigid “compressive-type” devices to suture-based configurations that allow variable tensioning upon insertion. Their advent and rapid evolution have undoubtedly revolutionized the practice of meniscal surgery.