AANA Lab Course 1002 -3rd Annual Fellows/Chief Residents-Meniscal Repair_ All Inside, Inside Out, Outside In-Denver T. Stanfield, M.D.

Meniscal Repair_ All Inside, Inside Out, Outside In-Denver T. Stanfield, M.D.

Pdf Summary

This presentation by Dr. Denver T. Stanfield focuses on meniscal repair techniques, indications, and surgical considerations for orthopedic surgeons. It emphasizes careful patient and tear evaluation to determine whether repair or removal is best. Key tear characteristics suited for repair include vertical, horizontal, flap, and complex tears that may be displaced or non-displaced, located in all meniscal zones (posterior, body, anterior), and varying in acuity (acute or chronic). Successful repair depends on vascular zones, patient age, activity level, symptoms, and co-morbidities.<br /><br />Surgical setup involves positioning the leg for varus and valgus stress, using appropriate portals, applying a tourniquet as needed, and employing diagnostic maneuvers such as the Gillquist maneuver to view the posterior compartments. Repairs should be performed cautiously to preserve healthy tissue with smooth, efficient technique and may require releasing ligaments to open joint compartments.<br /><br />Repair techniques include inside-out, outside-in, and all-inside approaches. The all-inside devices represent third-generation technology emphasizing suture-based fixation with strong vertical suture patterns matching meniscal fiber orientation. Surgeons should be versatile with various devices and practice their techniques outside the operating room.<br /><br />To optimize healing, surgeons should freshen tear edges, abrade synovium, microfracture the notch, and consider biologics. Protected rehabilitation is essential to allow tissue healing. Ideal repair candidates have tears located in the vascularized red-red zone with a narrow rim width, vertical or longitudinal configuration, length 1-4 cm, and often benefit from concurrent ACL reconstruction, though modern repair techniques show good outcomes with or without ACL surgery.<br /><br />The take-home message is to consider repairing most tears when feasible, use hybrid approaches, understand patient and tear factors, utilize multiple devices skillfully, create healing conditions, and be realistic yet bold in decision-making. Surgeons should study imaging carefully, understand anatomy, and anticipate challenges to maximize meniscal repair success.

Keywords

meniscal repair

orthopedic surgery

tear evaluation

surgical techniques

inside-out repair

outside-in repair

all-inside devices

vascular zones

rehabilitation

ACL reconstruction