APEX Knee Navigating Pearls and Pitfalls-All-inside, Inside-out, Outside-in: How do I Decide and How I Do It

All-inside, Inside-out, Outside-in: How do I Decide and How I Do It

Video Transcription

Video Summary

Lee Pace discusses meniscus repair techniques— all-inside, inside-out, and outside-in—highlighting the importance of anatomic reduction, biologic augmentation, and circumferential compression for successful healing. He classifies repairs as capsular-based (fixation anchoring to the capsule) or meniscal-based (suture contained within the meniscus), each suited to different tear locations and types. Medial meniscus tears often use capsular-based all-inside or inside-out repairs, especially posterior horn tears, while lateral meniscus posterior horn tears typically warrant meniscal-based repairs to preserve normal motion. Complex tears may require hybrid approaches. He explains the pros and cons of each technique: inside-out and outside-in offer strong fixation but need incisions and risk neurovascular injury, whereas all-inside is quicker with less dissection but may have implant limitations. Meniscal-based repairs suit radial and horizontal cleavage tears biomechanically better and avoid cartilage damage. Mastery of multiple approaches enables tailored, effective repairs depending on tear pattern, location, and meniscus side.

Asset Caption

Dr. Lee Pace

Keywords

meniscus repair techniques

all-inside repair

inside-out repair

outside-in repair

capsular-based repair

meniscal-based repair