Smaller Iatrogenic Defects Created by Inside-Out Compared With All-Inside Meniscus Repair Devices in Human Cadaveric Model

Editorial Commentary: Meniscus Repair Technique Must Be Determined on a Tear-by-Tear Basis: Hybrid Techniques Plus Biologics Are Optimal

Bucket-handle meniscus tears alter knee biomechanics and significantly elevate the risk of osteoarthritis when the tissue is not preserved. Consequentially, meniscus repair is preferred whenever possible to optimize load distribution and knee stability, with the overall goal of joint preservation. Bucket-handle meniscus tears have a higher rate of repair failure compared with many other tear patterns, and both the inside-out (IO) and all-inside (AI) techniques are acceptable options, each with distinct advantages and disadvantages. Both have demonstrated improved clinical outcomes with similar failure rates. IO is cost-effective and allows less meniscal trauma due to small-diameter needles, whereas disadvantages include increased surgical time, increased risk of infection, and the need for 1 or more skilled assistants. AI avoids extra incisions and extra assistants and shows decreased surgical time, whereas complications can include hardware irritation, chondral and neurovascular injury (particularly for posterolateral repairs), and motion loss. Hybrid repair using AI for posterior tears and IO for middle-third and outside-in for the anterior meniscus is cost-effective and efficacious. Biologics to promote healing through mechanical stimulation of the tear surfaces, notch marrow venting, trephination, and/or platelet-rich plasma can optimize the repair.

Application of Continuous Sewing Machine-Like Suture Technique in Meniscus Injury

Meniscus injury is a common type of knee joint injury and often requires arthroscopic repair. At present, meniscus repair methods mainly include inside-out technology, outside-in technology, and all-inside technology. Among them, all-inside technology has attracted more attention from clinicians because of its better results. To improve the shortcomings of all-inside technology, we describe a "continuous sewing machine-like" suture technique. Our technique can make the meniscus suture continuous, increase its flexibility, and also enhance the stability of the suture knot through multiple puncture suture. Our technology can be applied to more-complex meniscus injuries and can greatly reduce the cost of surgery.

Single Needle All-Inside Technique for Lateral Meniscus Repair at Popliteal Hiatus Area: Safe, Effective, and Time-Saving

The lateral meniscus tear at the popliteal hiatus area is a tricky problem in clinical treatment due to the difficulty of preoperative diagnosis, narrow space for operation, lack of capsular attachments, and risk of vascular injuries. This article introduces an arthroscopic single-needle, all-inside technique suitable for repairing longitudinal and horizontal lateral meniscus tears at the popliteus tendon hiatus area. We believe this technique is safe, effective, economical and reproducible.