Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 14, Issue 12, pp 1232–1237 | Cite as

Arthroscopic meniscal repair: a comparative study between three different surgical techniques

  • Michael E. HantesEmail author
  • Vasilios C. Zachos
  • Sokratis E. Varitimidis
  • Zoe H. Dailiana
  • Theophilos Karachalios
  • Konstantinos N. Malizos


The purpose of this prospective study was to evaluate and compare the results of arthroscopic meniscal repair using three different techniques. Between January 2002 and March 2004, 57 patients who met the inclusion criteria underwent an arthroscopic meniscal repair. The outside-in technique was used in 17 patients (group A), the inside-out in 20 patients (group B), while the rest of the 20 patients (group C) were managed by the all-inside technique using the Mitek RapidLoc soft tissue anchor (Mitek Surgical Products, Westwood, MA, USA). Anterior cruciate ligament (ACL) reconstruction was performed in 29 patients (51%). The criteria for clinical success included absence of joint line tenderness, locking, swelling, and a negative McMurray test. The minimum follow-up was one year for all groups. The mean follow-up was 23 months for group A, 22 months for group B, and 22 months for group C. All meniscal repairs were considered healed according to our criteria in group A, while 19 out of 20 repairs (95%) healed in group B. Finally 7 of 20 repairs (35%) were considered failures in group C and this difference was statistically significant in comparison with other groups. The time required for meniscal repair averaged 38.5 min for group A, 18.1 min for group B, and 13.6 min for group C. Operation time for meniscal repair in group A was statistically longer in comparison with other groups. There were no significant differences among the three groups concerning complications. According to our results, arhtroscopic meniscal repair with the inside-out technique seems to be superior in comparison with the other methods because it offers a high rate of meniscus healing without prolonged operation time.


Meniscal repair Outside-in Inside-out All-inside technique 


  1. 1.
    Ahn JH, Wang JH, Yoo JC (2004) Arthroscopic all-inside suture repair of medial meniscus lesion in anterior cruciate ligament-deficient knees: results of second look arthroscopies in 39 cases. Arthroscopy 20:936–945PubMedGoogle Scholar
  2. 2.
    Albrecht-Olsen P, Kristensen G, Törmälä P (1993) Meniscus bucket-handle fixation with an absorbable Biofix tack: development of a new technique. Knee Surg Sports Traumatol Arthrosc 1:104–106PubMedCrossRefGoogle Scholar
  3. 3.
    Albrecht-Olsen P, Kristensen G, Burgaard P, Joengersen U, Toerholm C (1999) The arrow versus horizontal suture in arthroscopic meniscus repair. Knee Surg Sports Traumatol Arthrosc 7:268–273PubMedCrossRefGoogle Scholar
  4. 4.
    Asik M, Sen C, Erginsu M (2002) Arthroscopic meniscal repair using T-fix. Knee Surg Sports Traumatol Arthrosc 10:284–288PubMedCrossRefGoogle Scholar
  5. 5.
    Austin KS, Sherman OH (1993) Complications of arthroscopic meniscal. Am J Sports Med 21:864–869PubMedGoogle Scholar
  6. 6.
    Barber AF (1987) Meniscus repair: results of an arthroscopic technique. Arthroscopy 3:25–30PubMedCrossRefGoogle Scholar
  7. 7.
    Barber FA, Click SD (1997) Meniscus repair rehabilitation with concurrent anterior cruciate reconstruction. Arthroscopy 13:433–437PubMedCrossRefGoogle Scholar
  8. 8.
    Barber FA, Herbert MA, Richards DP (2004) Load to failure testing of new meniscal repair devices. Arthroscopy 20:45–50PubMedCrossRefGoogle Scholar
  9. 9.
    Barrett GR, Field MH, Treacy SH, Ruff CG (1998) Clinical results of meniscus repair in patients 40 years and older. Arthroscopy 14:824–829PubMedCrossRefGoogle Scholar
  10. 10.
    Bonshahi AY, Hopgood P, Shepard CJ (2004) Migration of a broken arrow: a case report and review of the literature. Knee Surg Sports Traumatol Arthrosc 12:50–51PubMedCrossRefGoogle Scholar
  11. 11.
    Calder SJ, Myers PT (1999) Broken arrow: a complication of meniscal repair. Arthroscopy 15:651–652PubMedCrossRefGoogle Scholar
  12. 12.
    Cohen SB, Anderson MW, Miller MD (2003) Chondral injury after arthroscopic using bioabsorbable Mitek RapidLoc meniscal fixation. Arthroscopy 19:E24–E26PubMedCrossRefGoogle Scholar
  13. 13.
    De Haven KE, Black KP, Griffiths HJ (1989) Open meniscus repair. Technique and two to nine year results. Am J Sports Med 17:788–795Google Scholar
  14. 14.
    Gill SS, Diduch DR (2002) Outcomes after meniscal repair using the meniscus arrow in knees undergoing concurrent anterior cruciate ligament reconstruction. Arthroscopy 18:569–577PubMedCrossRefGoogle Scholar
  15. 15.
    Gliatis J, Kouzelis A, Panagopoulos A, Lambiris E (2005) Chondral injury due to migration of a Mitek RapidLoc meniscal repair implant after successful meniscal repair: a case report. Knee Surg Sports Traumatol Arthrosc 13:280–282PubMedCrossRefGoogle Scholar
  16. 16.
    Haas AL, Schepsis AA, Hornstein J, Edgar CM (2005) Meniscal repair using the Fast-Fix meniscal repair device. Arthroscopy 21:167–175PubMedCrossRefGoogle Scholar
  17. 17.
    Hantes ME, Kotsovolos ES, Mastrokalos DS, Ammenwerth J, Paessler HH (2005) Arthroscopic meniscal repair with an absorbable screw: results and surgical technique. Knee Surg Sports Traumatol Arthrosc 13:273–279PubMedCrossRefGoogle Scholar
  18. 18.
    Hechtmann KS, Uribe JW (1999) Cystic hematoma formation following use of a biodegradable arrow for meniscal repair. Arthroscopy 15:207–210CrossRefGoogle Scholar
  19. 19.
    Horibe S, Shino K, Nakata K, Maeda A, Nakamura N, Matsumoto N (1995) Second-look arthroscopy after meniscal repair. A review of 132 menisci repaired by an arthroscopic inside-out technique. J Bone Joint Surg Br 77:245–249PubMedGoogle Scholar
  20. 20.
    Jones HP, Lemos MJ, Wilk RM, Smiley PM, Gutierrez R, Schepsis AA (2002) Two-year follow-up of meniscal repair using a bioabsorbable arrow. Arthroscopy 18:64–69PubMedCrossRefGoogle Scholar
  21. 21.
    Kurzweil PR, Tifford CD, Ignacio EM (2005) Unsatisfactory clinical results of meniscal repair using the meniscus arrow. Arthroscopy 21:E 905CrossRefGoogle Scholar
  22. 22.
    Laprell H, Stein V, Petersen W (2002) Arthroscopic all-inside meniscus repair using a new refixation device: a prospective study. Arthroscopy 18:387–393PubMedCrossRefGoogle Scholar
  23. 23.
    Lee GP, Diduch DR (2005) Deteriorating outcomes after meniscal repair using the meniscus arrow in knees undergoing concurrent anterior cruciate ligament reconstruction: increased failure rate with long term follow-up. Am J Sports Med 33:1138–1141PubMedCrossRefGoogle Scholar
  24. 24.
    Miller DB (1988) Arthroscopic meniscus repair. Am J Sports Med 16:315–319PubMedGoogle Scholar
  25. 25.
    Morgan CD, Wojtys EM, Casscells CD, Casscells SW (1991) Arthroscopic meniscal repair evaluated by second look arthroscopy. Am J Sports Med 19:632–638PubMedGoogle Scholar
  26. 26.
    Muellner T, Egkher A, Nikolic A, Funovics M, Metz V (1999) Open meniscal repair: clinical and magnetic resonance inaging findings after 12 years. Am J Sports Med 27:16–20PubMedGoogle Scholar
  27. 27.
    Perdue PS, Hummer CD, Colosimo AJ, Heidt RS, Dormer SG (1996) Meniscal repair: outcomes and clinical follow up. Arthroscopy 12:694–698PubMedCrossRefGoogle Scholar
  28. 28.
    Rodeo SA, Warren RF (1996) Meniscal repair using the outside -to-inside technique. Clin Sports Med 15:469–481PubMedGoogle Scholar
  29. 29.
    Rosenberg TD, ScottSM, Coward DB, Dunbar WH, Ewing JW, Johnson CL, Paulos LE (1986) Arthroscopic meniscal repair evaluated with repeat arthroscopy. Arthroscopy 2:14–20PubMedCrossRefGoogle Scholar
  30. 30.
    Schutle KR, Fu FH (1996) Meniscal repair using the inside-to-outside technique. Clin Sports Med 15:455–467Google Scholar
  31. 31.
    Song EK, Lee KB, Yoon TR (2001) Aseptic synovitis after meniscal repair using the biodegradable meniscus arrow. Arthroscopy 17:77–80PubMedCrossRefGoogle Scholar
  32. 32.
    Spindler KP, McCarty EC, Warren TA, Devin C, Connor JT (2003) Prospective comparison of arthroscopic medial meniscal repair technique. Inside-out suture versus entirely arthroscopic arrows. Am J Sports Med 31:929–934PubMedGoogle Scholar
  33. 33.
    Steenbrugge F, Verdonk R, Huerel C, Verstraete K (2004) Arthroscopic meniscus repair: inside-out technique versus Biofix meniscus arrow. Knee Surg Sports Traumatol Arthrosc 12:43–49PubMedCrossRefGoogle Scholar
  34. 34.
    Stone RG, Frewin PR, Gonzales S (1990) Long-term assessment of arthroscopic meniscus repair: a two to six year follow-up study. Arthroscopy 6:73–78PubMedCrossRefGoogle Scholar
  35. 35.
    Tsai AM, McAllister DR, Chow S, Young CR, Hame SL (2004) Results of meniscal repair using a bioabsorbable screw. Arthroscopy 20:586–590PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Michael E. Hantes
    • 1
    Email author
  • Vasilios C. Zachos
    • 1
  • Sokratis E. Varitimidis
    • 1
  • Zoe H. Dailiana
    • 1
  • Theophilos Karachalios
    • 1
  • Konstantinos N. Malizos
    • 1
  1. 1.Department of Orthopaedic Surgery, Medical SchoolUniversity of Thessalia, University Hospital of LarissaLarissaGreece

Personalised recommendations