Meniscal Repair

Indications for Repair


Only 20% repairable


1. Red / Red longitudinal tear

- outer 3mm / meniscocapsular junction


Meniscal Tear Red RedMensical Repair all inside


2. Red / White longitudinal tear

- only one side of tear vascularised


Meniscal Red White TearMeniscal Tear Red White Repair


3. Young patient


Contraindications to repair 


1.  White / White

2.  Complex / Horizontal / Radial / Degenerative tears

3.  Tears that are stable & < 1 cm

4.  Meniscal tear in setting of torn ACL that is not being reconstructed

- high risk of re-tearing meniscus if knee unstable


Principles of Repair


1.  Debride tear 

- stimulate proliferative response

- remove mature scar

- with shaver / rasp


2.  Trephine meniscocapsular periphery

- with spinal needle to promote vascular channels


3.  Reduce mensical tear


4.  Suture placement

A.  Open repair

B.  Inside out

C.  All inside

D.  Outside in


5.  Increase chance of healing in isolated mensical repair

- fibrin clot

- intercondylar notch microfracture




1.  Open repair


Tibial plateau ORIF

- common to need to repair capsular avulsion of LM

- repair with 4.0 PDS / ethibond


2.  Inside out


Inside out Mensical Repair Structures at Risk





- double armed sutures with long flexible needles

- use single or double cannula system


Make open posteromedial / posterolateral approach

- retrieve the sutures needles as they exit the joint capsule

- protects neurological structures (saphenous / CPN) from needle or suture injury

- sutures then tied over capsule

- pass in flexion to protect structures


Pass the needles about the tear

- vertical or horizontal mattress sutures

- absorbable or non absorbable 2.0 suture

- every 2-3 mm


Tie sutures over capsule

- tie in extension or will break when patient extends leg


Meniscal Repair Inside OutMeniscal Repair Inside Out


Posteromedial incision

- placed at the posterior aspect of MFC

- knee at 90°

- 3-4 cm long vertical incision

- behind MCL

- protect saphenous nerve which runs in fat above the sartorius

- open sartorius fascia, retract to protect nerve

- displace medial head gastrocneumius posteriorly

- expose capsule


Posterolateral incision

- centred on joint line, just posterior to LCL

- knee at 90o

- above biceps and therefore CPN

- palpate LCL anteriorly

- Biceps is retracted inferiorly to protect CPN

- must dissect lateral gastronemius off capsule and retract

- this protects CPN and posterior neurovascular bundle


3.  All inside



- meniscal arrows (Biostinger, Meniscus Arrow)

- meniscal screws

- meniscal suture anchors (FasT-Fix, RapidLoc)


Technique FasT - Fix

- ipsilateral portal to view

- contralateral portal for instruments

- 2 x absorbable sutures anchors posteriorly

- may have to change portals for mensical body sutures

- pass first bioabsorbable anchors through meniscus and capsule

- retract and advance second anchor

- place anchor through meniscus (horizontal) or into capsule alone (vertical)

- advance knot, cut


All inside 1All inside 2All inside 3All inside 4


Meniscal Repair Posterior FastfixMeniscal Repair Posterior Fastfix Suture x 2Meniscus Post Repair


3.  Outside in


Indicated for anterior horn tears

- very difficult to get angle on the tear

- either with all inside or inside out


A.  Option 1

- camera in portal opposite to tear

- insert spinal needle through capsule and tear

- insert 1 PDS via spinal needle

- retrieve suture via anterior portal, tie a knot in end

- secure meniscus with knot

- repeat above step

- tie 2 sutures over outside of capsule


Anterior horn Meniscal TearAnterior horn meniscal tear Repair 1Anterior horn meniscal tear Repair 2


B.  Option 2

- insert PDS via spinal needle as above

- insert second spinal needle with loop PDS

- retrieve first PDS through that loop

- then pull single ended PDS back out through capsule
- tie over capsule


C.  Company made sets

- insert 2 hollow bore needles through capsule and meniscus

- insert single ended suture through one needle separate needle

- insert wire loop through other needle and retrieve

- tie over capsule through separate skin incision


Outside in Meniscal MenderMeniscal Repair Outside In First NeedleMensical Repair Outside In 2nd needle


Mensical Repair Outside In Advance SutureMeniscal Repair Outside In Retrieve with LoopMeniscal Repair Outside In


D.  Anchor repair

- insert anterior suture anchor

- pass sutures through meniscus and tie down

- technique used in meniscal transplant


Lateral Meniscus Anterior Horn TearAnterior Horn Tear ReducedAnterior Horn Tear Suture Passage


Anterior Horn Tear Suture Passage 2Anterior Horn Tear SuturesAnterior Horn Tear Final Repair


4.  Meniscal Root Repair



- tear of insertion of posterior horn of meniscus

- difficult to fix

- must repair down to bone



- ACL guide

- drill hole up into mensical root insertion

- use suture passer to secure meniscal root

- retrieve sutures down through bone tunnel in tibia

- tie over screw post


Mensical Root Repair 1Mensical Root Repair 2Mensical Root Repair 3Mensical Root Repair 4


Post operative rehab


Avoid weight bearing in flexion > 90o

- weight bear in extension / splint for 6 weeks

- range to 90o NWB