Outside-in Continuous Meniscal Suture Technique of the Knee

Abstract

The meniscus is largely responsible for the health and longevity of the knee. It has diverse functions, being fundamental in load absorption and distribution and even in joint stability. To preserve meniscal functions and prevent the occurrence of osteoarthritis after meniscectomy, several meniscal repair techniques have been developed. To perform meniscal repair in anterior horn, the outside-in technique is the most used. There are few devices for performing them, with most of the surgical techniques described using needles. Our group uses a device capable of performing meniscal repair in different ways. Our objective is to describe a continuous outside-in meniscal repair technique, especially indicated for anterior horn and meniscus body tears, with the “Meniscus 4-All suture device.” The continuous outside-in meniscal suture technique using this device is easy to perform, inexpensive, fast, and reproducible, minimizing the risk of soft-tissue entrapment. In addition, it allows the surgeon to perform meniscal repair in the posterior horn in extensive injuries with the same repair device, just switching to inside-out technique.

Outside‐in repair technique is effective in traumatic tears of the meniscus in active adults: a systematic review

“…One study analysed only lateral meniscus posterior root tears [68]. The outside‐in technique is the most appropriate for anterior horn tears because it allows a direct approach to the lesion and a stable fixation construct [53]. One study included only longitudinal meniscal tears [41].…”

“…The outside‐in technique was first described by Warren et al to decrease the risk of peroneal nerve injury [64]. The most common indication is an anterior horn tear, given the difficulty of reaching this area using the all‐inside technique [37, 53]. The lesion must be in the red‐red or red‐white zone, although successful meniscal repairs have been described in the white–white zone using fibrin clot augmentation [13, 36, 60].…”

Continuous Meniscal Suture in Radial Meniscal Tear: The Hourglass Technique

“…20 Since 2019, we have been using a Meniscus 4 A-II repair device (Síntegra Surgical, Pompéia -SP, Brazil), which allows meniscal suture to be performed continuously. [21][22][23][24] The purpose of this article is to describe the steps of continuous meniscal suture, in a format similar to an hourglass, for the treatment of radial lesions in the medial or lateral menisci. In Fig 1A to E, we can observe how the technique is configured.…”