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.
Keywords
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsAbbreviations
- LCL:
-
Lateral collateral ligament
- MCL:
-
Medial collateral ligament
References
Bland-Sutton J. Ligaments: their nature and morphology. 2nd ed. London; 1897.
Greis PE, Bardana DD, Holmstrom MC, Burks RT. Meniscal injury: 1. Basic science and evaluation. J Am Acad Orthop Surg. 2002;10(3):168–76.
McDermott ID, Amis AA. The consequences of meniscectomy. J Bone Joint Surg Br Vol. 2006;88(12): 1549–56.
Walker PS, Erkman MJ. The role of the menisci in force transmission across the knee. Clin Orthop Related Res. 1975;109:184–92.
Levy IM, Torzilli PA, Gould JUD, et al. The effect of medial meniscectomy on anterior-posterior motion of the knee. J Bone Joint Surg Am. 1982;64:883–8.
Annandale T. An operation for displaced semilunar cartilage. Br Med J. 1885;1(1268):779.
Delee J, Drez D, Miller M. DeLee & Drez’s orthopaedic sports medicine: principles and practice. 3rd ed. Philadelphia, PA: Elsevier; 2010.
Scott WN, editor. Surgery of the knee. 4th ed. Philadelphia, PA: Elsevier; 2006. p. 481–90.
Rispoli DM, Miller MD. Options in meniscal repair. Clin Sports Med. 1999;18(1):77–91.
Cannon WD, Vittori JM. The incidence of healing in arthroscopic meniscal repairs in anterior cruciate ligament-reconstructed knees versus stable knees. Am J Sports Med. 1992;20(2):176–81.
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.
DeHaven KE. Decision-making factors in the treatment of meniscal lesions. Clin Orthop Relat Res. 1990;252:49–54.
Ritchie JR, Miller MD, Bents RT, Smith DK. Meniscal repair in the goat model. The use of healing adjuncts and the role of magnetic resonance arthrography in repair evaluation. Am J Sports Med. 1998;26(2): 278–84.
Post WR, Akers SR, Kish V. Load to failure of common meniscal repair techniques: effects of suture technique and material. Arthroscopy. 1997;13(6): 731–6.
Scott GA, Jolly BL, Henning CE. Combined posterior incision and arthroscopic intra-articular repair of the meniscus: an examination of factors affecting healing. J Bone Joint Surg Am. 1986;68:847–61.
Warren RF. Arthroscopic meniscus repair. Arthroscopy. 1985;1:170–2.
Rodeo SA, Warren RF. Meniscal repair using the outside-to-inside technique. Clin Sports Med. 1996;15:469–81.
Rodeo SA. Arthroscopic meniscal repair with use of the outside-in technique. Instr Course Lect. 2000;49:195–206.
van Trommel MF, Simonian PT, Potter HG, et al. Different regional healing rates with the outside-in technique for meniscal repair. Am J Sports Med. 1998;26:446–52.
Laupattarakasem W, Sumanont S, Kesprayura S, Kasemkijwattana C. Arthroscopic outside-in meniscal repair through a needle hole. Arthroscopy. 2004;20(6):654–7.
Morgan CD. The “all-inside” meniscus repair. Arthroscopy. 1991;7(1):120–5.
Kocabey Y, Chang HC, Brand JC, et al. A biomechanical comparison of the FasT-Fix meniscal repair suture system and the RapidLoc device in cadaver meniscus. Arthroscopy. 2006;22:406–13.
Mehta VM, Terry MA. Cyclic testing of 3 all inside meniscal repair devices. Am J Sports Med. 2009;37(12):2435–9.
Barber FA, Herbert MA, Schroeder A, et al. Biomechanical testing of new meniscal repair techniques containing ultra high-molecular weight polyethylene suture. Arthroscopy. 2009;25:959–67.
Barber FA, Herbert MA, Bava ED, Drew OR. Biomechanical testing of suture-based meniscal repair devices containing ultrahigh-molecular weight polyethylene suture: update 2011. Arthroscopy. 2012 June;28(6):827–34.
Turman KA, Diduch DR, Miller MD. All-inside meniscal repair. Sports Health. 2009;1(5):438–44.
Kurzweil PR, Tifford CD, Ignacio EM. Unsatisfactory clinical results of meniscal repair using the meniscus arrow. Arthroscopy. 2005;21(8):905–7.
Lee GP, Diduch D. Deteriorating outcomes after meniscal repair using the meniscal arrow in knees undergoing concurrent anterior cruciate ligament reconstruction: increased failure rate with long-term follow-up. Am J Sports Med. 2005;33:1138–41.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2014 Springer Science+Business Media New York
About this chapter
Cite this chapter
Photopoulos, C.D., Kurzweil, P.R. (2014). Meniscal Repair Techniques. In: Kelly, IV, J. (eds) Meniscal Injuries. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8486-8_7
Download citation
DOI: https://doi.org/10.1007/978-1-4614-8486-8_7
Published:
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4614-8485-1
Online ISBN: 978-1-4614-8486-8
eBook Packages: MedicineMedicine (R0)