The outside-in technique for arthroscopic meniscal repair

The outside-in technique of arthroscopic repair is an effective technique for addressing the majority of reparable meniscal tears. It has additional application in performing meniscal transplants and applying fibrin clot to meniscal repairs. The ability to precisely control needle placement provides the advantage of protecting neurovascular structures that are frequently in close proximity. A particular disadvantage of this technique, however, is the difficulty in placing sutures perpendicular to tears located in the far posterior horns of the menisci. Attention should be paid to the vulnerable neurovascular structures both medially and laterally, and the leg should be appropriately positioned to minimize the risk of injury while passing needles and tying sutures over the capsule. When possible, vertically oriented sutures are preferred to evenly coapt the meniscus to the capsule. The addition of fibrin clot should be considered for radial split or isolated tears, and instructions for rehabilitation and weight-bearing should be individualized based on tear type, location, and vascularity.