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All-Inside Meniscus Repair

  • Meniscus (A Krych, Section Editor)
  • Published:
Current Reviews in Musculoskeletal Medicine Aims and scope Submit manuscript

Abstract

Purpose of Review

The indications for partial meniscectomy are becoming increasingly limited, and recent evidence suggests that the meniscus should be preserved whenever possible. Because of its many proposed advantages, all-inside meniscus repairs are becoming increasingly common. This review discusses the indications, advantages, disadvantages, and biomechanical and clinical outcomes of all-inside meniscus repair.

Recent Findings

All-inside meniscus repair demonstrates equal functional outcomes, healing rates, and complications compared to inside-out repair of vertical longitudinal and bucket-handle tears with the advantages of decreased surgical time and faster post-operative recovery. In addition, return-to-sport and activity levels are high following all-inside repair regardless of whether concomitant anterior cruciate ligament reconstruction is performed. Biomechanical studies have demonstrated advantages of all-inside meniscal based repairs on radial and horizontal tears.

Summary

All-inside meniscus repair compares favorably to inside-out repair of vertical longitudinal and bucket-handle tears and continues to increase in popularity. Both capsular based and meniscal based repairs can be used to repair a variety of tear patterns. While biomechanical results are encouraging, further research on the clinical outcomes of meniscal based repairs is needed to elucidate the role of these techniques in the future.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. McDermott ID, Amis AA. The consequences of meniscectomy. J Bone Joint Surg Br. 2006;88(12):1549–56. https://doi.org/10.1302/0301-620X.88B12.18140.

    Article  CAS  PubMed  Google Scholar 

  2. Andriacchi TP, Mundermann A, Smith RL, Alexander EJ, Dyrby CO, Koo S. A framework for the in vivo pathomechanics of osteoarthritis at the knee. Ann Biomed Eng. 2004;32(3):447–57. https://doi.org/10.1023/b:abme.0000017541.82498.37.

    Article  PubMed  Google Scholar 

  3. Jones MH, Spindler KP, Fleming BC, Duryea J, Obuchowski NA, Scaramuzza EA, Oksendahl HL, Winalski CS, Duong CL, Huston LJ, Parker RD, Kaeding CC, Andrish JT, Flanigan DC, Dunn WR, Reinke EK. Meniscus treatment and age associated with narrower radiographic joint space width 2-3 years after ACL reconstruction: data from the MOON onsite cohort. Osteoarthr Cartil. 2015;23(4):581–8. https://doi.org/10.1016/j.joca.2014.12.018.

    Article  CAS  Google Scholar 

  4. Roemer FW, Kwoh CK, Hannon MJ, Hunter DJ, Eckstein F, Grago J, Boudreau RM, Englund M, Guermazi A. Partial meniscectomy is associated with increased risk of incident radiographic osteoarthritis and worsening cartilage damage in the following year. Eur Radiol. 2017;27(1):404–13. https://doi.org/10.1007/s00330-016-4361-z.

    Article  PubMed  Google Scholar 

  5. Parker BR, Hurwitz S, Spang J, Creighton R, Kamath G. Surgical trends in the treatment of meniscal tears: analysis of data from the American Board of Orthopaedic Surgery Certification Examination Database. Am J Sports Med. 2016;44(7):1717–23. https://doi.org/10.1177/0363546516638082.

    Article  PubMed  Google Scholar 

  6. Ardizzone CA, Houck DA, McCartney DW, Vidal AF, Frank RM. All-inside repair of bucket-handle meniscal tears: clinical outcomes and prognostic factors. Am J Sports Med. 2020;48(13):3386–93. https://doi.org/10.1177/0363546520906141Systematic review showing overall failure rate of 29.3% after all-inside repair of bucket handle meniscus tears.

    Article  PubMed  Google Scholar 

  7. Harris B, Miller MD. Biomedical devices in meniscal repair. Sports Med Arthrosc Rev. 2006;14(3):120–8. https://doi.org/10.1097/00132585-200609000-00003.

    Article  PubMed  Google Scholar 

  8. Morgan CD. The “all-inside” meniscus repair. Arthroscopy. 1991;7(1):120–5. https://doi.org/10.1016/0749-8063(91)90093-d.

    Article  CAS  PubMed  Google Scholar 

  9. Stein T, Mehling AP, Welsch F, von Eisenhart-Rothe R, Jager A. Long-term outcome after arthroscopic meniscal repair versus arthroscopic partial meniscectomy for traumatic meniscal tears. Am J Sports Med. 2010;38(8):1542–8. https://doi.org/10.1177/0363546510364052.

    Article  PubMed  Google Scholar 

  10. Xu C, Zhao J. A meta-analysis comparing meniscal repair with meniscectomy in the treatment of meniscal tears: the more meniscus, the better outcome? Knee Surg Sports Traumatol Arthrosc. 2015;23(1):164–70. https://doi.org/10.1007/s00167-013-2528-6.

    Article  PubMed  Google Scholar 

  11. Feeley BT, Liu S, Garner AM, Zhang AL, Pietzsch JB. The cost-effectiveness of meniscal repair versus partial meniscectomy: a model-based projection for the United States. Knee. 2016;23(4):674–80. https://doi.org/10.1016/j.knee.2016.03.006.

    Article  PubMed  Google Scholar 

  12. Woodmass JM, LaPrade RF, Sgaglione NA, Nakamura N, Krych AJ. Meniscal repair: reconsidering indications, techniques, and biologic augmentation. J Bone Joint Surg Am. 2017;99(14):1222–31. https://doi.org/10.2106/JBJS.17.00297.

    Article  PubMed  Google Scholar 

  13. Noyes FR, Barber-Westin SD. Arthroscopic repair of meniscus tears extending into the avascular zone with or without anterior cruciate ligament reconstruction in patients 40 years of age and older. Arthroscopy. 2000;16(8):822–9. https://doi.org/10.1053/jars.2000.19434.

    Article  CAS  PubMed  Google Scholar 

  14. Kurzweil PR, Lynch NM, Coleman S, Kearney B. Repair of horizontal meniscus tears: a systematic review. Arthroscopy. 2014;30(11):1513–9. https://doi.org/10.1016/j.arthro.2014.05.038.

    Article  PubMed  Google Scholar 

  15. Beamer BS, Masoudi A, Walley KC, Harlow ER, Manoukian OS, Hertz B, Haeussler C, Olson JJ, Deangelis JP, Nazarian A, Ramappa AJ. Analysis of a new all-inside versus inside-out technique for repairing radial meniscal tears. Arthroscopy. 2015;31(2):293–8. https://doi.org/10.1016/j.arthro.2014.08.011.

    Article  PubMed  Google Scholar 

  16. Moulton SG, Bhatia S, Civitarese DM, Frank RM, Dean CS, LaPrade RF. Surgical techniques and outcomes of repairing meniscal radial tears: a systematic review. Arthroscopy. 2016;32(9):1919–25. https://doi.org/10.1016/j.arthro.2016.03.029.

    Article  PubMed  Google Scholar 

  17. Malinowski K, Goralczyk A, Hermanowicz K, LaPrade RF. Tips and pearls for all-inside medial meniscus repair. Arthrosc Tech. 2019;8(2):e131–e9. https://doi.org/10.1016/j.eats.2018.10.009Techniques for all-suture repair of various medial meniscus tears.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Marchetti DC, Phelps BM, Dahl KD, Slette EL, Mikula JD, Dornan GJ, et al. A contact pressure analysis comparing an all-inside and inside-out surgical repair technique for bucket-handle medial meniscus tears. Arthroscopy. 2017;33(10):1840–8. https://doi.org/10.1016/j.arthro.2017.04.013.

    Article  PubMed  Google Scholar 

  19. Cuellar A, Cuellar R, Diaz Heredia J, Cuellar A, Garcia-Alonso I, Ruiz-Iban MA. The all-inside meniscal repair technique has less risk of injury to the lateral geniculate artery than the inside-out repair technique when suturing the lateral meniscus. Knee Surg Sports Traumatol Arthrosc. 2018;26(3):793–8. https://doi.org/10.1007/s00167-017-4490-1.

    Article  PubMed  Google Scholar 

  20. Grant JA, Wilde J, Miller BS, Bedi A. Comparison of inside-out and all-inside techniques for the repair of isolated meniscal tears: a systematic review. Am J Sports Med. 2012;40(2):459–68. https://doi.org/10.1177/0363546511411701.

    Article  PubMed  Google Scholar 

  21. Westermann RW, Duchman KR, Amendola A, Glass N, Wolf BR. All-inside versus inside-out meniscal repair with concurrent anterior cruciate ligament reconstruction: a meta-regression analysis. Am J Sports Med. 2017;45(3):719–24. https://doi.org/10.1177/0363546516642220.

    Article  PubMed  Google Scholar 

  22. Fillingham YA, Riboh JC, Erickson BJ, Bach BR Jr, Yanke AB. Inside-out versus all-inside repair of isolated meniscal tears: an updated systematic review. Am J Sports Med. 2017;45(1):234–42. https://doi.org/10.1177/0363546516632504.

    Article  PubMed  Google Scholar 

  23. Elmallah R, Jones LC, Malloch L, Barrett GR. A meta-analysis of arthroscopic meniscal repair: inside-out versus outside-in versus all-inside techniques. J Knee Surg. 2019;32(8):750–7. https://doi.org/10.1055/s-0038-1668123Meta-analysis showing that all-inside and inside-out repairs have comparable healing rates, patient reported outcome scores, and complications.

    Article  PubMed  Google Scholar 

  24. Ayeni O, Peterson D, Chan K, Javidan A, Gandhi R. Suture repair versus arrow repair for symptomatic meniscus tears of the knee: a systematic review. J Knee Surg. 2012;25(5):397–402. https://doi.org/10.1055/s-0032-1313752.

    Article  PubMed  Google Scholar 

  25. Everhart JS, Higgins JD, Poland SG, Abouljoud MM, Flanigan DC. Meniscal repair in patients age 40years and older: a systematic review of 11 studies and 148 patients. Knee. 2018;25(6):1142–50. https://doi.org/10.1016/j.knee.2018.09.009.

    Article  PubMed  Google Scholar 

  26. Kang DG, Park YJ, Yu JH, Oh JB, Lee DY. A systematic review and meta-analysis of arthroscopic meniscus repair in young patients: comparison of all-inside and inside-out suture techniques. Knee Surg Relat Res. 2019;31(1):1–11. https://doi.org/10.5792/ksrr.17.078.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Monk P, Garfjeld Roberts P, Palmer AJ, Bayliss L, Mafi R, Beard D, et al. The urgent need for evidence in arthroscopic meniscal surgery. Am J Sports Med. 2017;45(4):965–73. https://doi.org/10.1177/0363546516650180.

    Article  PubMed  Google Scholar 

  28. Mutsaerts EL, van Eck CF, van de Graaf VA, Doornberg JN, van den Bekerom MP. Surgical interventions for meniscal tears: a closer look at the evidence. Arch Orthop Trauma Surg. 2016;136(3):361–70. https://doi.org/10.1007/s00402-015-2351-2.

    Article  PubMed  Google Scholar 

  29. Turman KA, Diduch DR, Miller MD. All-inside meniscal repair. Sports Health. 2009;1(5):438–44. https://doi.org/10.1177/1941738109334219.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Jones HP, Lemos MJ, Wilk RM, Smiley PM, Gutierrez R, Schepsis AA. Two-year follow-up of meniscal repair using a bioabsorbable arrow. Arthroscopy. 2002;18(1):64–9. https://doi.org/10.1053/jars.2002.25343.

    Article  PubMed  Google Scholar 

  31. Mao DW, Lee YHD. All-inside techniques for meniscal radial root tear repair. Arthrosc Tech. 2020;9(10):e1541–e5. https://doi.org/10.1016/j.eats.2020.06.016.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Buckland M, Sadoghi P, Wimmer MD, Vavken P, Pagenstert GI, Valderrabano V, et al. Meta-analysis on biomechanical properties of meniscus repairs: are devices better than sutures? Knee Surg Sports Traumatol Arthrosc. 2015;23(1):83–9. https://doi.org/10.1007/s00167-014-2966-9.

    Article  Google Scholar 

  33. Milchteim C, Branch EA, Maughon T, Hughey J, Anz AW. Biomechanical comparison of parallel and crossed suture repair for longitudinal meniscus tears. Orthop J Sports Med. 2016;4(4):2325967116640263. https://doi.org/10.1177/2325967116640263.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Samuelsen BT, Johnson NR, Hevesi M, Levy BA, Dahm DL, Stuart MJ, Krych AJ. Comparative outcomes of all-inside versus inside-out repair of bucket-handle meniscal tears: a propensity-matched analysis. Orthop J Sports Med. 2018;6(6):2325967118779045. https://doi.org/10.1177/2325967118779045.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Nepple JJ, Dunn WR, Wright RW. Meniscal repair outcomes at greater than five years: a systematic literature review and meta-analysis. J Bone Joint Surg Am. 2012;94(24):2222–7. https://doi.org/10.2106/JBJS.K.01584.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Alentorn-Geli E, Choi JH, Stuart JJ, Toth AP, Garrett WE, Taylor DC, Moorman C III. Inside-out or outside-in suturing should not be considered the standard repair method for radial tears of the midbody of the lateral meniscus: a systematic review and meta-analysis of biomechanical studies. J Knee Surg. 2016;29(7):604–12. https://doi.org/10.1055/s-0035-1570113.

    Article  PubMed  Google Scholar 

  37. Majeed H, Karuppiah S, Sigamoney KV, Geutjens G, Straw RG. All-inside meniscal repair surgery: factors affecting the outcome. J Orthop Traumatol. 2015;16(3):245–9. https://doi.org/10.1007/s10195-015-0342-2.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Bogunovic L, Kruse LM, Haas AK, Huston LJ, Wright RW. Outcome of all-inside second-generation meniscal repair: minimum five-year follow-up. J Bone Joint Surg Am. 2014;96(15):1303–7. https://doi.org/10.2106/JBJS.M.00266.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Totlis T, Haunschild ED, Otountzidis N, Stamou K, Condron NB, Tsikopoulos K, et al. Return-to-sport rate and activity level are high following arthroscopic all-inside meniscal repair with and without concomitant anterior cruciate ligament reconstruction: a systematic review. Arthroscopy. 2021;37(7):2351–60. https://doi.org/10.1016/j.arthro.2021.02.046Systematic review showing high return-to-sport rate and activity levels following all-inside meniscal repair, regardless of whether concomitant ACL reconstruction was performed.

    Article  PubMed  Google Scholar 

  40. Thaunat M, Jan N, Fayard JM, Kajetanek C, Murphy CG, Pupim B, Gardon R, Sonnery-Cottet B. Repair of meniscal ramp lesions through a posteromedial portal during anterior cruciate ligament reconstruction: outcome study with a minimum 2-year follow-up. Arthroscopy. 2016;32(11):2269–77. https://doi.org/10.1016/j.arthro.2016.02.026.

    Article  PubMed  Google Scholar 

  41. Keyhani S, Ahn JH, Verdonk R, Soleymanha M, Abbasian M. Arthroscopic all-inside ramp lesion repair using the posterolateral transseptal portal view. Knee Surg Sports Traumatol Arthrosc. 2017;25(2):454–8. https://doi.org/10.1007/s00167-016-4410-9.

    Article  PubMed  Google Scholar 

  42. Sonnery-Cottet B, Praz C, Rosenstiel N, Blakeney WG, Ouanezar H, Kandhari V, Vieira TD, Saithna A. Epidemiological evaluation of meniscal ramp lesions in 3214 anterior cruciate ligament-injured knees from the SANTI study group database: a risk factor analysis and study of secondary meniscectomy rates following 769 ramp repairs. Am J Sports Med. 2018;46(13):3189–97. https://doi.org/10.1177/0363546518800717.

    Article  PubMed  Google Scholar 

  43. Yeh SH, Hsu FW, Chen KH, Chiang ER, Chang MC, Ma HL. Repairing complete radial tears of the lateral meniscus: arthroscopic all-inside double vertical cross-suture technique is effective and safe with 2-year follow-up at minimum. Arthroscopy. 2021. https://doi.org/10.1016/j.arthro.2021.11.025.

  44. Choi NH, Kim TH, Son KM, Victoroff BN. Meniscal repair for radial tears of the midbody of the lateral meniscus. Am J Sports Med. 2010;38(12):2472–6. https://doi.org/10.1177/0363546510376736.

    Article  PubMed  Google Scholar 

  45. Zhuo H, Chen Q, Zhu F, Li J. Arthroscopic side-to-side repair for complete radial posterior lateral meniscus root tears. BMC Musculoskelet Disord. 2020;21(1):130. https://doi.org/10.1186/s12891-020-3156-1Retrospective case series of radial posterior lateral root tears with improved subjective and objective outcomes following repair with all-suture technique.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Tsujii A, Yonetani Y, Kinugasa K, Matsuo T, Yoneda K, Ohori T, Hamada M. Outcomes more than 2 years after meniscal repair for radial/flap tears of the posterior lateral meniscus combined with anterior cruciate ligament reconstruction. Am J Sports Med. 2019;47(12):2888–94. https://doi.org/10.1177/0363546519869955.

    Article  PubMed  Google Scholar 

  47. Choi NH, Son KM, Victoroff BN. Arthroscopic all-inside repair for a tear of posterior root of the medial meniscus: a technical note. Knee Surg Sports Traumatol Arthrosc. 2008;16(9):891–3. https://doi.org/10.1007/s00167-008-0581-3.

    Article  PubMed  Google Scholar 

  48. Doig T, Fagan P, Frush T, Lovse L, Chen C, Lemos S. The all-inside all-suture technique demonstrated better biomechanical behaviors in meniscus radial tear repair. Knee Surg Sports Traumatol Arthrosc. 2020;28(11):3606–12. https://doi.org/10.1007/s00167-020-06078-2Biomechanical study demonstrating better biomechanical behaviors for all-suture repair compared to capsular based and inside-out techniques.

    Article  PubMed  Google Scholar 

  49. Liodakis E, Dratzidis A, Kraemer M, Hurschler C, Krettek C, Hawi A, Omar M, Meller R, Hawi N. The lasso-loop, lasso-mattress and simple-cinch stitch for arthroscopic rotator cuff repair: are there biomechanical differences? Arch Orthop Trauma Surg. 2016;136(11):1581–5. https://doi.org/10.1007/s00402-016-2540-7.

    Article  PubMed  Google Scholar 

  50. Mhaskar VA. Alternative all-inside technique of repairing a vertical meniscus tear. Arthrosc Tech. 2020;9(8):e1181–e9. https://doi.org/10.1016/j.eats.2020.04.018.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Saliman JD. The circumferential compression stitch for meniscus repair. Arthrosc Tech. 2013;2(3):e257–64. https://doi.org/10.1016/j.eats.2013.02.016.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Zhang AL, Miller SL, Coughlin DG, Lotz JC, Feeley BT. Tibiofemoral contact pressures in radial tears of the meniscus treated with all-inside repair, inside-out repair and partial meniscectomy. Knee. 2015;22(5):400–4. https://doi.org/10.1016/j.knee.2015.05.008.

    Article  PubMed  Google Scholar 

  53. Branch EA, Milchteim C, Aspey BS, Liu W, Saliman JD, Anz AW. Biomechanical comparison of arthroscopic repair constructs for radial tears of the meniscus. Am J Sports Med. 2015;43(9):2270–6. https://doi.org/10.1177/0363546515591994.

    Article  PubMed  Google Scholar 

  54. Ogawa H, Matsumoto K, Sengoku M, Yoshioka H, Akiyama H. Arthroscopic repair of horizontal cleavage meniscus tears provides good clinical outcomes in spite of poor meniscus healing. Knee Surg Sports Traumatol Arthrosc. 2020;28(11):3474–80. https://doi.org/10.1007/s00167-019-05782-yRetrospective case series of horizontal-cleavage repairs and vertical-longitudinal repairs. Horizontal repairs demonstrated similar outcome scores despite poorer healing on MRI.

    Article  PubMed  Google Scholar 

  55. Beamer BS, Walley KC, Okajima S, Manoukian OS, Perez-Viloria M, DeAngelis JP, et al. Changes in contact area in meniscus horizontal cleavage tears subjected to repair and resection. Arthroscopy. 2017;33(3):617–24. https://doi.org/10.1016/j.arthro.2016.09.004.

    Article  PubMed  Google Scholar 

  56. Masoudi A, Beamer BS, Harlow ER, Manoukian OS, Walley KC, Hertz B, Haeussler C, Olson JJ, Zurakowski D, Nazarian A, Ramappa AJ, DeAngelis JP. Biomechanical evaluation of an all-inside suture-based device for repairing longitudinal meniscal tears. Arthroscopy. 2015;31(3):428–34. https://doi.org/10.1016/j.arthro.2014.08.027.

    Article  PubMed  Google Scholar 

  57. Circumferential compression STITCH repairs of complex and horizontal cleavage meniscal tears (NOVOSTITCH PRO). ClinicalTrials.gov Identifier NCT04361487.

  58. Predictors of early success from circumferential compression STITCH meniscal repairs (STITCHRetro). ClinicalTrials.gov Identifier NCT03097744.

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Authors and Affiliations

  1. Cedars-Sinai Kerlan-Jobe Institute, Los Angeles, CA, 90045, USA

    A. G. Golz & B. Mandelbaum

  2. Children’s Health Andrew’s Institute, Plano, TX, 75024, USA

    J. L. Pace

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Andrew Golz declares that he has no conflict of interest. Lee Pace declares that he is a consultant for Arthrex and JRF and is a committee member for the Pediatric Research in Sports Medicine (PRiSM) Society. Bert Mandelbaum declares that he is a consultant and receives royalties from Arthrex and is on the board of Cedars-Sinai Kerlan-Jobe institute.

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Golz, A.G., Mandelbaum, B. & Pace, J.L. All-Inside Meniscus Repair. Curr Rev Musculoskelet Med 15, 252–258 (2022). https://doi.org/10.1007/s12178-022-09766-3

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