Inside-out meniscus repair

The long-term adverse effects of meniscectomy reported by many investigators has led to a treatment philosophy of meniscal repair and preservation whenever possible. Meniscal repair should allow a successful return by most patients to an active lifestyle with a decreased risk of developing osteoarthritis. Many different techniques of meniscal repair have been developed. The inside-out arthroscopic-assisted meniscal repair, developed by Henning, features: 1) meniscal and meniscosynovial abrasion to promote vascular healing, 2) cannulated suture-needle delivery system for suture placement, and 3) a posteromedial or lateral skin incision for needle retrieval to avoid neurovascular complications. The inside-out arthroscopic-assisted technique has been reproducible with an acceptable complication rate. It is time consuming and technically demanding, but offers considerable advantages over excision for ultimate knee function. The purpose of this chapter is to describe the indication, operative technique, postoperative rehabilitation and results of inside-out meniscal repair.