Editorial Commentary: Repair of Radial Meniscus Tears

Treatment of meniscus injuries has evolved from open to arthroscopic, from total to partial meniscectomy, and ultimately towards meniscus preservation. In theory, almost all tear types can be repaired, including root tears, (oblique) radial tears, horizontal cleavage tears, vertical tears, and even complex tears, as a result of improved surgical techniques and tools. Meniscus repair outcomes literature may be confounded by the lack of inclusion of control groups, as well as concomitant anterior cruciate ligament injury and reconstruction, augmentation with fibrin clot or platelet-rich plasma or other biologics, suture configuration, and timing of repair. Radial tears represent a most difficult pattern due to limited fixation strength, suturing circumferential fibers and technical challenge. However, successful meniscus repair outcomes can be obtained in this difficult tear pattern. The key to success for any radial repair, regardless of technique, is to create a tensionless repair, and one of the key components is anatomic reduction of the meniscus. Using all-inside suture devices to place a traction stitch can assist in reducing the meniscus. Then, all-inside or inside-out techniques may be used to repair the meniscus to the capsule in an anatomic position (vertical mattress), with rip-stop sutures to create horizontal or oblique sutures across the tear. With the meniscus reduced anatomically, mismatch from intra- to extracapsular distance is prevented.