Inside-out repair of complex tears in the posterior horn of the lateral meniscus

Abstract

All-inside meniscus devices are preferred over inside-out sutures for complex tears in the posterior horn of the lateral meniscus due to the ease of use, avoidance of additional skin incisions, and reduced surgical time. However, inside-out sutures have the advantages of being less traumatic due to smaller diameter needles, better healing rate, and less chance of injuries to posterior neurovascular structures due to direct visualization and protection. To the author’s knowledge, the inside-out repair technique has been described only for vertical tears and not for complex tears in the posterior horn of the lateral meniscus. This video describes the technique of repairing complex lateral meniscus tears with inside-out sutures using various suture configurations. The lateral meniscus tear pattern is identified. A posterolateral safety incision is made, and a retractor is placed posterior to the capsule. The popliteal vein is identified at this step and kept under visualization to avoid injury. Meniscal repair configurations such as “H,” “X,” and “A” patterns and simple vertical or horizontal sutures are planned according to the tear pattern. Sutures are passed using inside-out meniscal sutures, 18G spinal needle, self-retrieving suture devices or a combination of those, and tied over the capsule using sliding knots while the repair site is arthroscopically visualized.