Outside-in technique

Written by Dr Sheila Strover on March 14, 2025

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.

One needle allow the sure to be passed through a retractable loop in the second suture
Looking down on the one meniscus from above. The needles are inserted through the skin to pass the stitches.

A row of mattress sutures using a looped thread to pull the other one through both sides of the defect. The knot is tied outside the capsule.

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.

specific advantages of this technique include the ability to predictably avoid neurovascular injury"

SA Rodeo

although......

Care must be taken to avoid tying the sutures around a branch of the saphenous nerve during repair of the medial meniscus."

SA Rodeo

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