Meniscus tears and repair: assessing failure rates of all-inside and outside-in methods

Abstract

Meniscal repair procedures are on the rise due to an enhanced understanding of the adverse long-term effects associated with the loss of meniscal tissue. Although meniscal repair has a higher reoperation rates compared to meniscectomy, recent systematic reviews indicate improved long-term outcomes with meniscal repair. Even though there are a lot of studies that compare the results of all-inside and inside-out techniques there are only few that evaluate all-inside and outside-in approaches. This study aims to review the relevant literature on the epidemiology, mechanism of injury, clinical presentation and imaging of meniscus and to compare the failure rates and time to failure of AI and OI meniscal repairs. PubMed and Scopus were searched for studies published between January 2014 and January 2024 reporting on meniscus repair outcomes using “outside-in” or “all-inside” techniques with a minimal duration of 6 months for follow-up. Failure was characterized as the recurrence of clinical symptoms or the need for a meniscal reintervention. Over 50 English-language articles were analyzed between 2000 and 2022. After conducting a review and data analysis, it is observed that the “all-inside” technique is more frequently chosen as a treatment method, possibly due to its simpler execution. Both total and percentage rates of failures are higher using this technique, amounting to 79 cases and reaching 16%, compared to “outside-in” approach, which is less commonly chosen, but has lower frequency of failures totaling 6 cases and 5%.