Meniscus Repair of the Anterior Third: The Outside-In Option

Abstract

Outside-in meniscal repair is an effective and often most optimal technique for addressing tears involving the anterior one-third of the meniscus. It can be performed without an assistant with standard arthroscopy instrumentation. Although the technique may be used for tears in the anterior two-thirds of both the lateral and medial meniscus, it is most commonly utilized for anterior one-third tears, which are not often accessible with other techniques. Knowledge of the anatomy of the saphenous and peroneal nerves in relation to flexion of the knee is paramount to avoiding iatrogenic injury. The technique involves passing sutures through spinal needles that are placed percutaneously from outside-in across the meniscal tear. There are various modifications of the basic technique that may be performed depending on available instrumentation and surgeon preference. Although repairable anterior one-third tears are not as common as posterior horn tears, proficiency with the outside-in technique can be quite valuable and often ideal in this setting. Multiple authors have reported excellent healing rates. With proper attention to needle placement, complications are rare.