The outside-in technique refers to meniscus repair where a needle is introduced into the knee from the skin through the two adjacent parts of torn meniscus, under arthroscopic visual control.
Indications for outside-in repair
The surgeon may choose to tie a knot ('mulberry knot') from inside pulling the torn bits together or a 'vertical mattress' suture can be used which is a bit more challenging. The procedure is particularly used for tears of the anterior horn of the meniscus, as well as suturing a meniscus allograft or implant. It avoids the risk of nerve damage and also avoids a large skin incision.
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Meniscal Repair and Reconstruction. Jarit GJ and Bosco JA. Bulletin of the NYU Hospital for Joint Diseases 2010;68(2):84-90
Arthroscopic meniscal repair with use of the outside-in technique. Rodeo SA. Instr Course Lect. 2000;49:195-206.