All-inside or inside-out meniscus repair: what is the difference, and which will I have?

All-inside repair

All-inside devices carry a stitch and small anchors that sit behind the meniscus capsule. The surgeon passes them through the standard keyhole incisions and tightens the stitch inside the joint.

• Well suited to tears at the back of the meniscus, the posterior horn, which is the commonest site
• No extra incision, and generally quick to perform
• Fewer options for very front-of-knee tears, and the anchors are fixed once placed

Inside-out repair

Long needles carrying stitches are passed from inside the joint, through the meniscus and out through the capsule, where they are retrieved and tied through a small incision on the inner or outer side of the knee.

• Allows many closely spaced stitches, useful for long tears such as bucket-handle tears
• Works well in the middle portion of the meniscus
• Needs a small extra incision and careful protection of nearby nerves and vessels

Outside-in repair

Needles are passed from outside the knee, through the skin and capsule, into the joint and across the tear. This suits tears at the front of the meniscus, which are awkward to reach with the other methods.

How the choice is made

The surgeon chooses during arthroscopy, once the tear has been seen and probed: its length, position from front to back, distance from the rim and tissue quality all matter. Root tears use a different method again, reattaching the meniscus to bone through a small tunnel. For patients, recovery is guided far more by the tear type and whether an ACL reconstruction was done than by the stitching technique. Dr. Gelber explains the likely plan from your MRI before surgery in Doha.