Hybrid Sequential Meniscal Suture Technique

Meniscal preservation is a priority in the treatment of knee injuries because of the fundamental role of the meniscus in load absorption, joint stability, and chondral protection. Several repair techniques have been described, including inside-out, outside-in, and all-inside approaches. More recently, continuous suturing techniques have emerged as a promising alternative, allowing multiple fixation points with shorter operative time and reduced costs. We describe a hybrid continuous meniscal repair technique that combines initial all-inside fixation with additional outside-in sutures using the excess suture limb from the implant. The repair begins with meniscal fixation using an all-inside device, after which the free suture end is redirected percutaneously through successive outside-in passages, creating a continuous vertical suture construct. This strategy enables multiple fixation points from a single device, potentially enhancing biomechanical stability and reducing the need for additional implants. The integration of all-inside and outside-in fixation allows the entire extent of the tear to be addressed in a safe, reproducible, and cost-effective manner. The described hybrid technique expands the applicability of continuous meniscal suturing and may contribute to improved clinical outcomes in meniscal preservation.