Posterolateral approach for all-inside arthroscopic lateral meniscus repair in athletes: technique and outcomes

The past 2 decades have been marked by substantial progress in our knowledge of meniscus anatomy, function, and biomechanics, and also by the shifting of the surgical treatment of meniscal lesions from traditional meniscectomy towards arthroscopic repair to get away from the early osteoarthritis associated with meniscectomy. Posterior horn injuries of the lateral meniscus (LM) have been less studied due to their lower incidence and also due to the historical technical complexity of performing a repair in the posterolateral compartment.

A retrospective analysis of prospectively collected data was performed of all athletic patients who had a peripheral longitudinal tear of the lateral meniscal posterior horn and who underwent at least one repair procedure with a posterolateral approach between 2014 and 2018. The type of injury, extent of lateral meniscal tear, and characteristics of sutures placed were assessed. Clinical assessment included objective and subjective IKDC ratings. The Tegner activity level score was determined before the injury and at the last follow-up visit. Failure was defined as a need for revision surgery. All complications were documented.

The study population comprised 24 athletes with a mean follow-up of 25.2 ± 10 months. The Tegner activity level was exactly the same before the injury as after the surgery. The mean IKDC score significantly increased from 41.8 (12.2) before the surgery to 94.5 (9.1) after. There were four reoperations for failure (16.6%) that required a new suture repair. None of these revised repairs sustained a new failure as of the last follow-up.

Despite the long learning curve, the posterolateral approach is a safe and effective technique for longitudinal tears of the posterior horn of the LM. The results of all-inside suture repair through a posterolateral portal are comparable to other techniques.