Hybrid Inside-Out-Outside-In Meniscal Repair Through a Small Skin Incision.

Area of Science:

• Orthopedic Surgery
• Sports Medicine
• Knee Arthroscopy

Background:

• Meniscal repair techniques aim to restore knee function and prevent osteoarthritis.
• All-inside meniscal repair devices offer convenience but may have limitations.
• The traditional inside-out technique, while effective, requires a larger accessory incision, posing risks of neurovascular injury and soft-tissue entrapment, particularly at the posterior horn of the meniscus.

Purpose of the Study:

• To present a novel hybrid inside-out-outside-in technique for meniscal repair.
• To minimize the accessory incision size and associated risks in posterior horn meniscal repairs.
• To offer a refined approach that combines advantages of both inside-out and outside-in techniques.

Main Methods:

• A hybrid technique utilizing a commercial inside-out device for initial needle guidance.
• Employing a spinal needle in an outside-in manner through a small, bluntly dissected track for subsequent needle retrieval.
• Adaptable insertion of subsequent meniscal needles (inside-out or outside-in) based on suture construct design.

Main Results:

• The hybrid technique successfully minimizes the accessory incision volume.
• It mitigates the risk of soft-tissue entrapment and neurovascular injury during needle retrieval.
• The technique allows for flexible suture construct placement, accommodating various meniscal tear configurations.

Conclusions:

• The hybrid inside-out-outside-in technique provides a safe and effective alternative for meniscal repair, especially for posterior horn tears.
• This method reduces surgical morbidity by minimizing incision size and associated risks.
• It represents a valuable refinement in arthroscopic meniscal repair procedures.