Meniscal Repair Techniques



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.


Joint Line Biceps Femoris Meniscal Tear Lateral Collateral Ligament Meniscal Repair 
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Lateral collateral ligament


Medial collateral ligament


  1. 1.
    Bland-Sutton J. Ligaments: their nature and morphology. 2nd ed. London; 1897.Google Scholar
  2. 2.
    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.PubMedGoogle Scholar
  3. 3.
    McDermott ID, Amis AA. The consequences of meniscectomy. J Bone Joint Surg Br Vol. 2006;88(12): 1549–56.CrossRefGoogle Scholar
  4. 4.
    Walker PS, Erkman MJ. The role of the menisci in force transmission across the knee. Clin Orthop Related Res. 1975;109:184–92.CrossRefGoogle Scholar
  5. 5.
    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.PubMedGoogle Scholar
  6. 6.
    Annandale T. An operation for displaced semilunar cartilage. Br Med J. 1885;1(1268):779.PubMedCrossRefGoogle Scholar
  7. 7.
    Delee J, Drez D, Miller M. DeLee & Drez’s orthopaedic sports medicine: principles and practice. 3rd ed. Philadelphia, PA: Elsevier; 2010.Google Scholar
  8. 8.
    Scott WN, editor. Surgery of the knee. 4th ed. Philadelphia, PA: Elsevier; 2006. p. 481–90.Google Scholar
  9. 9.
    Rispoli DM, Miller MD. Options in meniscal repair. Clin Sports Med. 1999;18(1):77–91.PubMedCrossRefGoogle Scholar
  10. 10.
    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.PubMedCrossRefGoogle Scholar
  11. 11.
    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.PubMedCrossRefGoogle Scholar
  12. 12.
    DeHaven KE. Decision-making factors in the treatment of meniscal lesions. Clin Orthop Relat Res. 1990;252:49–54.PubMedGoogle Scholar
  13. 13.
    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.PubMedGoogle Scholar
  14. 14.
    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.PubMedCrossRefGoogle Scholar
  15. 15.
    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.PubMedGoogle Scholar
  16. 16.
    Warren RF. Arthroscopic meniscus repair. Arthroscopy. 1985;1:170–2.PubMedCrossRefGoogle Scholar
  17. 17.
    Rodeo SA, Warren RF. Meniscal repair using the outside-to-inside technique. Clin Sports Med. 1996;15:469–81.PubMedGoogle Scholar
  18. 18.
    Rodeo SA. Arthroscopic meniscal repair with use of the outside-in technique. Instr Course Lect. 2000;49:195–206.PubMedGoogle Scholar
  19. 19.
    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.PubMedGoogle Scholar
  20. 20.
    Laupattarakasem W, Sumanont S, Kesprayura S, Kasemkijwattana C. Arthroscopic outside-in meniscal repair through a needle hole. Arthroscopy. 2004;20(6):654–7.PubMedCrossRefGoogle Scholar
  21. 21.
    Morgan CD. The “all-inside” meniscus repair. Arthroscopy. 1991;7(1):120–5.PubMedCrossRefGoogle Scholar
  22. 22.
    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.PubMedCrossRefGoogle Scholar
  23. 23.
    Mehta VM, Terry MA. Cyclic testing of 3 all inside meniscal repair devices. Am J Sports Med. 2009;37(12):2435–9.PubMedCrossRefGoogle Scholar
  24. 24.
    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.PubMedCrossRefGoogle Scholar
  25. 25.
    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.PubMedCrossRefGoogle Scholar
  26. 26.
    Turman KA, Diduch DR, Miller MD. All-inside meniscal repair. Sports Health. 2009;1(5):438–44.PubMedCrossRefGoogle Scholar
  27. 27.
    Kurzweil PR, Tifford CD, Ignacio EM. Unsatisfactory clinical results of meniscal repair using the meniscus arrow. Arthroscopy. 2005;21(8):905–7.PubMedGoogle Scholar
  28. 28.
    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.PubMedCrossRefGoogle Scholar

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© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Hospital of the University of PennsylvaniaPhiladelphiaUSA
  2. 2.Memorial Orthopaedic Surgical GroupLong BeachUSA

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