Semimembranosus Tendon-Sparing Arthroscopic Inside-Out Repair of a Medial Meniscus Bucket-Handle Tear

Bucket-handle tears of the medial meniscus are a common knee injury. Meniscal repair restores stability, reduces degenerative changes, and improves clinical outcomes. Repair may be performed using all-inside, outside-in, or inside-out techniques. Among these, the inside-out technique is widely regarded as the gold standard because of its reliability and broad applicability. However, blind needle passage during inside-out repair carries a risk of semimembranosus tendon entrapment. The purpose of this technical note is to describe a step-by-step surgical technique for inside-out repair of medial meniscus bucket-handle tears that recognizes and addresses entrapment of the semimembranosus tendon.