Abstract
Meniscal repair has been introduced to preserve knee function and limit the accelerated
degenerative changes associated with meniscal tissue resection. Arthroscopic techniques
have evolved to improve morbidity. However, there are few clinical outcome studies
in the peer-reviewed literature that compare the use of these approaches. Therefore,
our purpose was to perform a meta-analysis of the existing literature on arthroscopic
meniscal repair techniques. Specifically, we evaluated differences in: (1) operating
time; (2) incidence of postoperative meniscal healing; (3) functional outcomes, using
various scoring systems; and (4) incidence of complications. We searched the peer-reviewed
literature using SCOPUS, Medline, EMBASE, and Web of Science. Eight studies were eligible
for the meta-analysis. These included one prospective, randomized trial (level I),
three prospective, comparative studies (level II), and four retrospective, comparative
studies (level III). There were a total of 476 patients who had a mean follow-up between
3 and 156 months. When evaluating objective outcomes, the inside-out technique had
a significantly higher mean operating time than the all-inside technique. The inside-out
and all-inside techniques had comparable meniscal healing rates, but the outside-in
repair had a significantly higher rate of meniscal healing than the all-inside repair.
Upon assessment of functional outcomes, the inside-out and all-inside methods had
comparable International Knee Documentation Committee and Tegner activity scores,
but the all-inside method had greater improvements in Lysholm scores. The inside-out
and all-inside repairs had similar overall complication rates. All-inside repair may
demonstrate lower operating times, but the outside-in repair may have superior meniscal
healing rates. Functional outcomes are overall comparable between the techniques.
However, there are limited clinical data on the outcome differences between these
procedures, and further comparative studies with longer follow-up are needed.
Keywords
arthroscopic meniscal repair - inside-out - all-inside - outside-in
