AOSSM/AANA Specialty Day 2020-Decision-Making_ All-Inside vs. Inside-Out Meniscus Repair

Decision-Making_ All-Inside vs. Inside-Out Meniscus Repair_

Pdf Summary

This presentation by Dr. Michael J. Stuart from the Mayo Clinic compares two primary techniques for meniscus repair: All-Inside and Inside-Out, focusing on their advantages, disadvantages, outcomes, and preferred indications.

Key elements for successful meniscus repair include anatomic reduction, biologic preparation or augmentation, and achieving circumferential compression, summarized as the “ABC’s of Meniscus Repair.”

<strong>All-Inside Repair</strong> is noted for its simplicity, speed, one-handed insertion, and versatility in treating most tear configurations, especially small tears and the far posterior horn. It avoids knot tying and is suited for posterior meniscus access. However, it uses intra-articular knots, has large-bore needles that may cause larger perforations, and is generally more expensive.

<strong>Inside-Out Repair</strong> uses extra-capsular implants with no intra-articular knots, small-bore solid needles, and provides a strong repair construct (70-113N). It is versatile for all tear types, favored for large tears and multiple sutures, such as bucket handle tears. The downsides include requiring two assistants, being time-consuming, needing an additional incision, and increased risk of needle stick.

Research comparing both techniques—including 27 studies, randomized controlled trials, and prospective comparative studies—shows no significant difference in failure rates (around 20% in each group), healing success, outcome scores, or complications.

The presentation recommends combining both methods depending on the tear pattern: All-Inside for small or far posterior tears, Inside-Out for large tears needing multiple sutures, and both for complex bucket handle tears.

The overall message emphasizes the importance of preserving the meniscus through appropriate repair techniques tailored to the tear type, to optimize outcomes and joint health.

Keywords

Meniscus repair

All-Inside technique

Inside-Out technique

Meniscus tear

Surgical outcomes

Knot tying

Needle size

Bucket handle tear

Tear pattern

Meniscus preservation