AANA/ISAKOS Knee and Shoulder Arthroscopy Course-Online Didactics (April 2024)-All-Inside, Inside-Out, Outside-In

All-Inside, Inside-Out, Outside-In_ How I Decide and How I Do It

Video Transcription

Video Summary

In this 2020 Anna Knee-Shoulder course lecture, Kevin Bonner discusses meniscus repair techniques: all-inside, inside-out, and outside-in approaches. He explains the indications, advantages, and limitations of each method based on tear location and complexity. All-inside repairs using PLEDGET-type devices are popular for small posterior tears due to their efficiency and avoidance of posterior incisions but carry risks like device misfire and potential meniscus damage. Inside-out repair remains the gold standard for larger, complex, or mid-posterior tears, offering precise, multiple fixation points with minimal meniscus damage, though it requires experience and more operative time. Outside-in repair is preferred for anterior third tears. Bonner emphasizes the need for surgeons to master all techniques to tailor repair to the tear and patient, advocating inside-out proficiency despite a trend toward all-inside repairs. Overall, successful meniscus repair demands anatomic restoration with attention to long-term outcomes and patient safety.

Keywords

meniscus repair

all-inside technique

inside-out technique

outside-in technique

meniscus tear management