Inside-out meniscus repair

Abstract

Meniscus repair over resection, when feasible, should be strongly considered in an effort to preserve meniscus integrity and function, especially in younger patients. Currently, a number of techniques and implants may be used to achieve a successful result. Although all-inside meniscus repair devices have evolved significantly since their introduction and have become the repair technique of choice for many surgeons, the classic inside-out repair technique is still very useful to have in one's armamentarium. Though less popular because of the ease of current-generation fixators, the inside-out technique can still offer advantages for those surgeons who are proficient. With the versatility to address most tear patterns, the ability to deliver sutures with smaller needle diameters, and proven long-term results, it has been considered the gold standard in meniscus repair. We review the inside-out repair technique for both a medial and lateral meniscus tear with some helpful tips when performing the technique, and we present a video demonstration of the lateral meniscus repair technique.

Figure 1

The proper location for the posteromedial incision is shown. A 2.5- to 4-cm incision is made posterior to the medial collateral ligament with two-thirds of the incision distal to the joint line. The pes tendons are retracted posterior with the saphenous nerve. The proper interval is continued between the medial head of the gastrocnemius and the joint capsule.

Figure 2

(A) Illustration showing inside-out medial meniscus repair. The needle is deflected toward the assistant with the retractor placed anterior to the medial head of the gastrocnemius. (B) Illustration showing inside-out lateral meniscus repair. A retractor placed anterior to the lateral head of the gastrocnemius protects the neurovascular structures.

Figure 3

The proper location for the posterolateral approach is shown. A 2.5- to 4-cm incision is made posterior to the lateral collateral ligament with two-thirds of the incision distal to the joint line. The proper approach interval is between the iliotibial band and the biceps tendon. The proper interval is continued between the lateral head of the gastrocnemius and the joint capsule.

Figure 4

Arthroscopic images of right lateral meniscal tear and subsequent repair. (A) Unstable tear of lateral meniscus at the meniscocapsular junction before repair. Hemorrhage is present at the tear site. (B) Vertical mattress sutures are placed on the femoral side of the posterior horn of the lateral meniscus. (C) Tibial-sided vertical mattress sutures are placed in a similar fashion. (D) Capturing the popliteus tendon was avoided in this case.