Abstract: Technical advancements in meniscal repairs have greatly contributed to the ability
to repair a variety of meniscal tears that were once thought untreatable. The gold-standard
treatment for arthroscopic meniscal body repair remains an inside-out technique. The
advantages of this technique are innate to the low-profile nature of the suture-passing
construct, which allows for perpendicular access to tears with the benefit of multiple
fixation points, in contrast to often bulkier all-inside repair devices. This technique
requires a posteromedial or posterolateral incision for safe suture passing and needle
retrieval and necessitates a surgical team experienced in this method of repair. However,
the newest generation of all-inside devices has allowed for more facile placement
of a variety of suture types. The all-inside repair technique includes both capsular-based
and meniscal-based fixation, is not limited by a need for additional experienced surgical
personnel to pass and retrieve needles, and does not require additional incisions.
Regardless of fixation type, meniscal repair has been shown to improve long-term functional
scores when compared with meniscectomy. Additionally, biological adjuncts have been
introduced into the repair algorithm to improve healing rates when performing isolated
meniscal repairs. Preparing the healing site with abrasion or trephination creates
vascular channels that can facilitate repair. Intercondylar-notch marrow venting attempts
to replicate the environment created by anterior cruciate ligament drilling for which
healing rates are notably higher than those with isolated meniscal repairs. The use
of fibrin clots in inside-out meniscal repairs with suturing of the clot to the area
of the tear has also shown promising early healing rates on both magnetic resonance
imaging and second-look arthroscopy. Finally, biological adjuncts such as platelet-rich
plasma and concentrated bone marrow aspirate have shown both early clinical and radiographic
improvements in Level IV case series, but further research is needed to more definitively
measure their utility in the setting of meniscal repair.
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Article info
Publication history
Published online: January 13, 2021
Footnotes
The authors report no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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Published by Elsevier on behalf of the Arthroscopy Association of North America